MEDICARE: ALPHA RECOVERY 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	103TA0400X	Addiction (Substance Use Disorder) Psychologist

General Provider Information

NPI Number	:	1750938171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA RECOVERY SERVICES LLC

Provider Business Mailing Address
First Line	:	16 STEVENS RD
Second Line	:
City	:	NORTH READING
State	:	MA
Zip	:	01864-3216
Country	:	US
Telephone Number	:	617-435-9783
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 STEVENS RD
Second Line	:
City	:	NORTH READING
State	:	MA
Zip	:	01864-3216
Country	:	US
Telephone Number	:	617-435-9783
Fax Number	:

Authorized Official
Title or Position	:	OWNER, OPERATOR
Name	:	MATTHEW GANEM
Credential	:
Telephone Number	:	617-435-9783

Provider Enumeration Date	:	08/20/2019
Last Update Date	:	08/20/2019

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