MEDICARE: RENOVA RECOVERY, LLC

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
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1043171242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENOVA RECOVERY, LLC

Provider Business Mailing Address
First Line	:	35 BEAVERSON BLVD STE 6A
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08723-7859
Country	:	US
Telephone Number	:	609-509-9533
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 BEAVERSON BLVD STE 6A
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08723-7859
Country	:	US
Telephone Number	:	609-509-9533
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	ROBERT SALMONS
Credential	:
Telephone Number	:	609-509-9533

Provider Enumeration Date	:	11/19/2025
Last Update Date	:	11/19/2025

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Directions to “RENOVA RECOVERY, LLC ” Practice Location

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