MEDICARE: TRI AMERICA RECOVERY

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	3245S0500X	Children's Substance Abuse Rehabilitation Facility
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1750049284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI AMERICA RECOVERY

Provider Business Mailing Address
First Line	:	2185 LEMOINE AVE UNIT 1H
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6030
Country	:	US
Telephone Number	:	877-658-0182
Fax Number	:

Provider Business Practice Location Address
First Line	:	2185 LEMOINE AVE UNIT 1H
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6030
Country	:	US
Telephone Number	:	877-427-8180
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED PERSON
Name	:	TRACY LARUSSO
Credential	:
Telephone Number	:	877-658-0182

Provider Enumeration Date	:	12/01/2021
Last Update Date	:	03/08/2026

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2185 LEMOINE AVE UNIT 1G
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Directions to “TRI AMERICA RECOVERY ” Practice Location

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