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General NPI Number Information
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NPI Number | 1437064029
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Entity Type | Organization
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Legal Business Name | COMMUNITY RECOVERY MAINE LLC
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Dates
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Enumeration Date | 08/17/2026
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Last Update Date | 08/17/2026
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Provider Practice Location Address
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Address Line | 97 ELM ST
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City | SOUTH THOMASTON
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State | ME
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Zip | 04858-3031
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Country | US
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Telephone | 207-907-5052
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Fax |
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Provider Business Mailing Address
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Address Line | 133 S DOHENY DR APT 303
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City | LOS ANGELES
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State | CA
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Zip | 90048-2941
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Country | US
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Telephone | 207-317-7783
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Fax |
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Authorized Official
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Title or Position | FOUNDER AND CEO
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Name | SINA KANGAVARI
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Credential |
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Telephone | 310-866-6246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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