=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538977707
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REAL RECOVERY CENTERS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2024
-----------------------------------------------------
Last Update Date | 03/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 67 PARKHURST RD STE 2
-----------------------------------------------------
City | CHELMSFORD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01824-1518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-319-1697
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 88 CENTRAL ST
-----------------------------------------------------
City | NORTH READING
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01864-3207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-319-1697
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | SCOTT LANDRY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 978-319-1697
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0401X
-----------------------------------------------------
Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------