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General NPI Number Information
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NPI Number | 1356611289
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Entity Type | Organization
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Legal Business Name | RECOVERY EDGE PEER SUPPORT AND RECOVERY SERVICES, INC.
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Dates
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Enumeration Date | 01/10/2012
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Last Update Date | 01/10/2012
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Provider Practice Location Address
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Address Line | 18 N 2ND ST FIRST FLOOR
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City | POTTSVILLE
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State | PA
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Zip | 17901-2903
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Country | US
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Telephone | 570-516-9094
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 18
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City | FRIEDENSBURG
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State | PA
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Zip | 17933-0018
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Country | US
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Telephone | 570-621-8533
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Fax |
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Authorized Official
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Title or Position | CHEIF OPERATING OFFICER
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Name | MR. EDWARD L PERHONITCH JR.
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Credential | CPS/FORENSIC SPECIAL
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Telephone | 570-621-8533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 223720
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License Number State | PA
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