=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962263889
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EVEREST RECOVERY CENTERS - MASSACHUSETTS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2024
-----------------------------------------------------
Last Update Date | 01/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14 CHESTNUT PL
-----------------------------------------------------
City | LUDLOW
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01056-3476
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-300-0010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 7651
-----------------------------------------------------
City | CUMBERLAND
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02864-0897
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-300-0010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/CO-OWNER
-----------------------------------------------------
Name | PETER F MORRIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 401-533-1832
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------