MEDICARE: RECOVERY CITY HEALTHCARE SERVICES 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1346048899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECOVERY CITY HEALTHCARE SERVICES LLC

Provider Business Mailing Address
First Line	:	2509 WASHINGTON BLVD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21230-1406
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2509 WASHINGTON BLVD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21230-1406
Country	:	US
Telephone Number	:	240-713-9873
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	OPEYINKA ADESUNLOYE
Credential	:
Telephone Number	:	240-713-9873

Provider Enumeration Date	:	03/03/2025
Last Update Date	:	03/03/2025

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