MEDICARE: RESIDENTIAL RECOVERY SERVICES

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1073863783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESIDENTIAL RECOVERY SERVICES

Provider Business Mailing Address
First Line	:	201 S JOHNSON RD
Second Line	:	SUITE 200
City	:	HOUSTON
State	:	PA
Zip	:	15342-1351
Country	:	US
Telephone Number	:	724-745-7535
Fax Number	:	724-745-3383

Provider Business Practice Location Address
First Line	:	201 S JOHNSON RD
Second Line	:	SUITE 200
City	:	HOUSTON
State	:	PA
Zip	:	15342-1351
Country	:	US
Telephone Number	:	724-745-7535
Fax Number	:	724-745-3383

Authorized Official
Title or Position	:	DIRECTOR
Name	:	HOLLY C CALLENDER
Credential	:	LSW
Telephone Number	:	724-745-7535

Provider Enumeration Date	:	09/11/2012
Last Update Date	:	09/11/2012

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Directions to “RESIDENTIAL RECOVERY SERVICES ” Practice Location

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