MEDICARE: RECOVERY INNOVATIONS OF PENNSYLVANIA

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1932349487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECOVERY INNOVATIONS OF PENNSYLVANIA

Provider Business Mailing Address
First Line	:	2701 N 16TH ST STE 316
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-1266
Country	:	US
Telephone Number	:	602-650-1212
Fax Number	:	602-636-5211

Provider Business Practice Location Address
First Line	:	4040 MARKET ST STE 100
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-3003
Country	:	US
Telephone Number	:	814-330-1010
Fax Number	:

Authorized Official
Title or Position	:	RSA
Name	:	MICHAEL BRODY
Credential	:	LCSW
Telephone Number	:	814-330-1010

Provider Enumeration Date	:	02/24/2009
Last Update Date	:	02/24/2009

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Directions to “RECOVERY INNOVATIONS OF PENNSYLVANIA ” Practice Location

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