=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477263689
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEWIS RECOVERY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2022
-----------------------------------------------------
Last Update Date | 11/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 326 N LEWIS RD STE 200
-----------------------------------------------------
City | ROYERSFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19468-1586
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-275-6755
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 326 N LEWIS RD
-----------------------------------------------------
City | ROYERSFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19468-1586
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-570-6620
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHEIF CLINICAL OFFICER
-----------------------------------------------------
Name | STEVE KUSHNER
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 215-275-6755
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------