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General NPI Number Information
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NPI Number | 1881006294
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Entity Type | Organization
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Legal Business Name | RECOVERY FOR LIFE, INC.
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Dates
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Enumeration Date | 05/20/2014
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Last Update Date | 05/20/2014
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Provider Practice Location Address
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Address Line | 3719 E BALTIMORE ST
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City | BALTIMORE
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State | MD
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Zip | 21224-1509
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Country | US
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Telephone | 410-276-2212
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Fax | 410-814-0434
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Provider Business Mailing Address
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Address Line | 3719 E BALTIMORE ST
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City | BALTIMORE
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State | MD
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Zip | 21224-1509
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Country | US
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Telephone | 410-276-2212
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Fax | 410-814-0434
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Authorized Official
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Title or Position | PROGRAM SPONSOR
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Name | MR. LOUIS SALVATORE SPATH
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Credential |
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Telephone | 410-276-2212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LC3785
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License Number State | MD
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