MEDICARE: PORT RECOVERY IOP INC.

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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1881587764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORT RECOVERY IOP INC.

Provider Business Mailing Address
First Line	:	8615 RIDGELYS CHOICE DR STE 205
Second Line	:
City	:	NOTTINGHAM
State	:	MD
Zip	:	21236-3028
Country	:	US
Telephone Number	:	443-869-4909
Fax Number	:	443-869-4928

Provider Business Practice Location Address
First Line	:	2701 KILDAIRE DR
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21234-7634
Country	:	US
Telephone Number	:	443-869-4909
Fax Number	:	443-869-4928

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MATTHEW FINLEY
Credential	:
Telephone Number	:	443-869-4909

Provider Enumeration Date	:	05/30/2025
Last Update Date	:	05/30/2025

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