MEDICARE: CARE RECOVERY, 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	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1851017636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARE RECOVERY, LLC

Provider Business Mailing Address
First Line	:	4345 BAINTREE RD
Second Line	:
City	:	UNIVERSITY HEIGHTS
State	:	OH
Zip	:	44118-3930
Country	:	US
Telephone Number	:	781-608-1487
Fax Number	:

Provider Business Practice Location Address
First Line	:	4345 BAINTREE RD
Second Line	:
City	:	UNIVERSITY HEIGHTS
State	:	OH
Zip	:	44118-3930
Country	:	US
Telephone Number	:	781-608-1487
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ADAM CUSNER
Credential	:	PHD
Telephone Number	:	740-338-2273

Provider Enumeration Date	:	10/13/2022
Last Update Date	:	11/21/2022

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