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NPI Code Detail

MEDICARE: PORT RECOVERY, INC.

MEDICARE: PORT RECOVERY, INC.
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
1171M00000XCase Manager/Care Coordinator
2175T00000XPeer Specialist
3251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1043623465
Entity Type Code : Organization
Provider Name (Legal Business Name) : PORT RECOVERY, INC.
Provider Business Mailing Address
First Line : 8615 RIDGELYS CHOICE DR STE 205
Second Line :
City : NOTTINGHAM
State : MD
Zip : 21236-3028
Country : US
Telephone Number : 443-869-4909
Fax Number : 410-534-8737
Provider Business Practice Location Address
First Line : 8615 RIDGELYS CHOICE DR STE 205
Second Line :
City : NOTTINGHAM
State : MD
Zip : 21236-3028
Country : US
Telephone Number : 443-869-4909
Fax Number : 443-869-4928
Authorized Official
Title or Position : PROGRAM DIRECTOR
Name : MATTHEW FINLEY
Credential :
Telephone Number : 443-869-4909
Provider Enumeration Date : 06/03/2014
Last Update Date : 01/28/2025

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