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General NPI Number Information
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NPI Number | 1457173379
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Entity Type | Organization
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Legal Business Name | LUNA RECOVERY FOR WOMEN, LLC
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Dates
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Enumeration Date | 10/30/2024
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 1270 TURNPIKE ST
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City | NORTH ANDOVER
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State | MA
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Zip | 01845-6116
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Country | US
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Telephone | 978-490-0215
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Fax |
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Provider Business Mailing Address
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Address Line | 1 HIGHWOOD DR STE 104
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City | TEWKSBURY
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State | MA
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Zip | 01876-1156
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Country | US
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Telephone | 978-490-0215
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ANDREA STANFORD
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Credential |
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Telephone | 978-490-0215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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