NPIMap

Organization Active NPI

Port Recovery Iop Inc.

  • Substance Abuse Rehabilitation Facility
  • Baltimore, MD
National Provider Identifier
1073385613
Registry record updated Oct 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
PORT RECOVERY IOP INC.
Practice address
2917 Bayonne Ave
Baltimore, MD 21214-1726
Phone
(443) 869-4909
Fax
(443) 869-4928
NPI assigned
Oct 26, 2023
Last updated
Oct 26, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Matthew Finley
Title
Program Director
Phone
(443) 869-4909

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

2917 Bayonne Ave
Baltimore, MD 21214-1726

Mailing address

8615 Ridgelys Choice Dr Ste 205
Nottingham, MD 21236-3028
Phone (434) 869-4909

Other identifiers 3

IdentifierTypeStateIssuer
6804021MedicaidMD
6800271MedicaidMD
6800297MedicaidMD

National Provider Directory

National Provider Directory
Tax ID family
Port Recovery Iop Inc11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1698278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698278400000",
    "number": "1073385613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8615 RIDGELYS CHOICE DR STE 205",
            "city": "NOTTINGHAM",
            "state": "MD",
            "postal_code": "212363028",
            "telephone_number": "434-869-4909",
            "fax_number": "443-869-4928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2917 BAYONNE AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212141726",
            "telephone_number": "443-869-4909",
            "fax_number": "443-869-4928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT RECOVERY IOP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-26",
        "last_updated": "2023-10-26",
        "certification_date": "2023-10-26",
        "status": "A",
        "authorized_official_last_name": "FINLEY",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "443-869-4909"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6804021",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6800271",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6800297",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.