MEDICARE: RAY RECOVERY OH 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1285315259
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAY RECOVERY OH LLC

Provider Business Mailing Address
First Line	:	4403 15TH AVE STE 196
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-1604
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1737 GEORGETOWN RD STE HI
Second Line	:
City	:	HUDSON
State	:	OH
Zip	:	44236-5013
Country	:	US
Telephone Number	:	212-461-4729
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LEONARD FREUND
Credential	:
Telephone Number	:	212-461-4729

Provider Enumeration Date	:	07/31/2023
Last Update Date	:	09/10/2023

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Directions to “RAY RECOVERY OH LLC ” Practice Location

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