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General NPI Number Information
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NPI Number | 1326811506
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Entity Type | Organization
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Legal Business Name | MAINE RECOVERY COLLECTIVE, LLC
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Dates
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Enumeration Date | 10/31/2023
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Last Update Date | 05/31/2024
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Provider Practice Location Address
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Address Line | 56 MOSHER ST
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-2122
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Country | US
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Telephone | 617-690-9020
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Fax |
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Provider Business Mailing Address
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Address Line | 22 REDLON RD
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City | PORTLAND
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State | ME
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Zip | 04102-2218
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Country | US
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Telephone | 617-690-9020
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Fax |
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Authorized Official
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Title or Position | CONSULTANT/PRESIDENT
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Name | MISS LISA MARIE NASHAWATY
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Credential |
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Telephone | 617-690-9020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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