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General NPI Number Information
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NPI Number | 1962277640
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Entity Type | Organization
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Legal Business Name | RECOVERY 180 VIRGINIA LLC
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Dates
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Enumeration Date | 11/22/2023
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Last Update Date | 01/30/2024
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Provider Practice Location Address
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Address Line | 6791 JAMES MADISON HWY
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City | WARRENTON
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State | VA
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Zip | 20187-9534
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Country | US
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Telephone | 443-289-8606
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 BUSINESS PKWY S STE 1
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City | WESTMINSTER
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State | MD
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Zip | 21157-3048
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Country | US
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Telephone | 443-204-5800
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF COMPLIANCE
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Name | DESIREE MOUNTAIN
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Credential |
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Telephone | 443-204-5800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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