MEDICARE: COMPLETE RECOVERY LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QC1500X	Community Health Clinic/Center
2	251S00000X	Community/Behavioral Health Agency
3	261Q00000X	Clinic/Center
4	261QR0800X	Recovery Care Clinic/Center
5	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1164908067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE RECOVERY LLC

Provider Business Mailing Address
First Line	:	13001 CEDAR RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118-2751
Country	:	US
Telephone Number	:	216-426-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	13001 CEDAR RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118-2751
Country	:	US
Telephone Number	:	216-426-6000
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. IAN STANICH
Credential	:
Telephone Number	:	216-273-8400

Provider Enumeration Date	:	07/13/2018
Last Update Date	:	03/22/2022

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