Recovery Source LLC

Primary specialty

Lodging ProviderTaxonomy code 177F00000X

Legal business name

RECOVERY SOURCE LLC

Practice address

115 N Main St
North East, MD 21901-3502

Phone

(410) 441-4617

NPI assigned

Dec 18, 2019

Organization subpart

No

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

Authorized official

Name

Patricia Jones

Title

Director of Operations

Phone

(410) 441-4617

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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

{
    "created_epoch": "1576627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576627200000",
    "number": "1093353252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 ROLLING AVE",
            "city": "NORTH EAST",
            "state": "MD",
            "postal_code": "219016328",
            "telephone_number": "410-441-4617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 N MAIN ST",
            "city": "NORTH EAST",
            "state": "MD",
            "postal_code": "219013502",
            "telephone_number": "410-441-4617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RECOVERY SOURCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-18",
        "last_updated": "2019-12-18",
        "certification_date": "2019-12-18",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "410-441-4617"
    },
    "taxonomies": [
        {
            "code": "177F00000X",
            "taxonomy_group": "",
            "desc": "Lodging",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "819671",
            "state": "MD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "pjones@dexterhouse.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "115 N Main St",
            "city": "North East",
            "state": "MD",
            "country_code": "US",
            "postal_code": "219013502",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Lodging Provider in North East, MD
• Providers in North East, MD by specialty
• Lodging Provider in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2019; 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.