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General NPI Number Information
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NPI Number | 1699121343
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Entity Type | Organization
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Legal Business Name | ADDICTION RECOVERY NETWORK LLC
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Dates
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Enumeration Date | 05/12/2016
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Last Update Date | 03/31/2020
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Provider Practice Location Address
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Address Line | 428 WASHINGTON ST SUITE 2
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City | WATERTOWN
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State | NY
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Zip | 13601-4832
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Country | US
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Telephone | 315-405-8038
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Fax | 315-405-8999
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Provider Business Mailing Address
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Address Line | PO BOX 247
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City | WATERTOWN
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State | NY
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Zip | 13601-0247
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Country | US
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Telephone | 315-783-5581
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLES J MOEHS
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Credential | MD
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Telephone | 315-783-5581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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