MEDICARE: RECOVERY180 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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1427787944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECOVERY180 LLC

Provider Business Mailing Address
First Line	:	1100 BUSINESS PKWY S STE 1
Second Line	:
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-3048
Country	:	US
Telephone Number	:	443-204-5800
Fax Number	:

Provider Business Practice Location Address
First Line	:	5438 SANDY HILL RD
Second Line	:
City	:	QUANTICO
State	:	MD
Zip	:	21856-2100
Country	:	US
Telephone Number	:	443-204-5800
Fax Number	:

Authorized Official
Title or Position	:	COMPLIANCE OFFICER
Name	:	DESIREE MOUNTAIN
Credential	:
Telephone Number	:	443-204-5800

Provider Enumeration Date	:	06/09/2022
Last Update Date	:	06/09/2022

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Directions to “RECOVERY180 LLC ” Practice Location

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