| Port Recovery Iop Inc. | |
|
8615 Ridgelys Choice Dr Ste 205 Nottingham MD 21236-3028 | |
| (443) 869-4909 | |
| (443) 869-4928 |
| Full Name | Port Recovery Iop Inc. |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 8615 Ridgelys Choice Dr Ste 205, Nottingham, Maryland |
| Authorized Official Name and Position | Joanne Granruth (OWNER) |
| Authorized Official Contact | 4105348735 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Port Recovery Iop Inc. 8615 Ridgelys Choice Dr Ste 205 Nottingham MD 21236-3028 Ph: (410) 534-8735 | Port Recovery Iop Inc. 8615 Ridgelys Choice Dr Ste 205 Nottingham MD 21236-3028 Ph: (443) 869-4909 |
| NPI Number | 1598234601 |
|---|---|
| Provider Enumeration Date | 11/19/2018 |
| Last Update Date | 04/14/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598234601 | NPI | - | NPPES |
| 680402101 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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