=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578363214
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEXUS RECOVERY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2025
-----------------------------------------------------
Last Update Date | 12/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9R SHORT ST
-----------------------------------------------------
City | WORCESTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01604-3320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-630-9023
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 TURNPIKE RD STE 150
-----------------------------------------------------
City | SOUTHBOROUGH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01772-2174
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-630-9023
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | RYAN VARTANIAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 603-631-9023
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------