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General NPI Number Information
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NPI Number | 1568114262
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Entity Type | Organization
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Legal Business Name | PEER RECOVERY AND THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 01/24/2022
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Last Update Date | 07/29/2024
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Provider Practice Location Address
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Address Line | 10 HALE ST STE 200
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City | CHARLESTON
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State | WV
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Zip | 25301-2830
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Country | US
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Telephone | 304-544-5453
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Fax | 304-841-0688
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Provider Business Mailing Address
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Address Line | 10 HALE ST STE 200
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City | CHARLESTON
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State | WV
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Zip | 25301-2830
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Country | US
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Telephone | 304-544-5453
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Fax | 304-841-0688
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW NELSON
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Credential |
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Telephone | 304-551-1266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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