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General NPI Number Information
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NPI Number | 1336841451
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Entity Type | Organization
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Legal Business Name | INTO ACTION RECOVERY SERVICES LLC
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Dates
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Enumeration Date | 03/21/2023
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Last Update Date | 03/21/2023
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Provider Practice Location Address
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Address Line | 273 DUBUQUE ST
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City | MANCHESTER
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State | NH
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Zip | 03102-3706
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Country | US
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Telephone | 781-248-3360
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Fax |
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Provider Business Mailing Address
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Address Line | 273 DUBUQUE ST
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City | MANCHESTER
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State | NH
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Zip | 03102-3706
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Country | US
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Telephone | 781-248-3360
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | JONATHAN GERSON
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Credential |
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Telephone | 781-248-3360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #6
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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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Taxonomy #7
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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