MEDICARE: RAY RECOVERY OH 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1962246413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAY RECOVERY OH LLC

Provider Business Mailing Address
First Line	:	4403 15TH AVE STE 196
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-1604
Country	:	US
Telephone Number	:	212-461-4729
Fax Number	:

Provider Business Practice Location Address
First Line	:	1737 GEORGETOWN RD
Second Line	:
City	:	HUDSON
State	:	OH
Zip	:	44236-5013
Country	:	US
Telephone Number	:	330-355-9729
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. LEONARD FREUND
Credential	:
Telephone Number	:	330-355-9729

Provider Enumeration Date	:	06/20/2024
Last Update Date	:	06/20/2024

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