Port Recovery Iop Inc.
Organization Active NPI Mental Health Counselor · Nottingham, MD
NPI 1578026464 · NPPES record last updated Apr 9, 2019
Key facts
- NPI
- 1578026464
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Counselor 101YM0800X
- Legal business name
- PORT RECOVERY IOP INC.
- Practice address
- 8615 Ridgelys Choice Dr Ste 205
Nottingham, MD 21236-3028 - Phone
- (443) 869-4909
- Fax
- (443) 869-4928
- NPI assigned
- Apr 9, 2019
- Organization subpart
- No
Authorized official
- Name
- Joanne Granruth
- Title
- Owner
- Phone
- (410) 534-8735
Corporate family (same tax ID) 10
Practitioners 4
-
Elaine Malvina Cook, CRNP
-
Carol Garey, LCSW-C
-
Randal A Steele, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190919000034 | MD | Part B Supplier - Clinic/Group Practice | 2961650551 |
Receives reassigned benefits from 4 practitioners Practice locations: Nottingham, MD |
National Provider Directory
- Tax ID family
- Port Recovery Iop Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | Yes | ||
| Professional Counselor |
101YP2500X | |||
| Clinical Social Worker |
1041C0700X | |||
| Psychiatry Physician |
2084P0800X | |||
| Psychiatric/Mental Health Nurse Practitioner |
363LP0808X |
Addresses
Primary practice location
8615 Ridgelys Choice Dr Ste 205
Nottingham, MD 21236-3028
Mailing address
8615 Ridgelys Choice Dr Ste 205
Nottingham, MD 21236-3028
Phone (443) 869-4909
Other providers in Nottingham, MD
- Christie Pona
- Sylvia Poole
- Port Recovery Iop Inc.
- Port Recovery Iop Inc.
- Port Recovery Iop Inc.
- Port Recovery Iop Inc.
- Port Recovery Iop Inc.
- Port Recovery Iop Inc.
- Port Recovery Mental Health, Inc.
- Port Recovery Physicians Care LLC
All providers in Nottingham, MD · Mental Health Counselor in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 9, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.