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NPI Code Detail

MEDICARE: DISCOVERY HOUSE RF

MEDICARE: DISCOVERY HOUSE RF
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM2800XMethadone ClinicA72600001AIL
2261QM0850XAdult Mental Health Clinic/CenterA72600001AIL

General Provider Information

NPI Number : 1023289048
Entity Type Code : Organization
Provider Name (Legal Business Name) : DISCOVERY HOUSE RF
Provider Business Mailing Address
First Line : 66 PAVILION AVE
Second Line :
City : PROVIDENCE
State : RI
Zip : 02905-1522
Country : US
Telephone Number : 401-780-2300
Fax Number : 401-780-2397
Provider Business Practice Location Address
First Line : 4855 E STATE ST
Second Line :
City : ROCKFORD
State : IL
Zip : 61108-2274
Country : US
Telephone Number : 815-484-0900
Fax Number : 815-484-1010
Authorized Official
Title or Position : COO
Name : PETER F MORRIS
Credential :
Telephone Number : 401-780-2300
Provider Enumeration Date : 03/18/2008
Last Update Date : 03/18/2008

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