THE RECOVERY VILLAGE MARYLAND, LLC (NPI# 1871949388) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871949388 |
| Entity Type | Organization |
| Organization Name | THE RECOVERY VILLAGE MARYLAND, LLC |
| Other Organization Name | IAFF CENTER OF EXCELLENCE FOR BEHAVIORAL HEALTH TREATMENT AND RECOVERY |
| Practice Address |
13400 Edgemeade Road Upper Marlboro MD 20772 |
| Mailing Address |
100 Se 3rd Ave Suite 1800 Ft Lauderdale FL 33394-0002 |
| Practice Telephone | 7543003120 |
| Practice Fax Number | 8889194431 |
| Mailing Telephone | 7543003120 |
| Mailing Fax Number | 8889194431 |
| Enumeration Date | 2016-05-13 |
| Last Update Date | 2019-06-17 |
| Authorized Official Name | BELINA SURUJON (LICENSING & CONTRACTING DIRECTOR) |
| Authorized Official Telephone | 7543003120 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 323P00000X | Psychiatric Residential Treatment Facility | 16-023 | MD | Residential Treatment Facilities |
| Y | 324500000X | Substance Abuse Rehabilitation Facility | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| IAFF Center of Excellence for Behavioral Health Treatment and Recovery | Doing Business As Name - Organization |
| Street Address |
13400 EDGEMEADE ROAD |
| City | UPPER MARLBORO |
| State | MD |
| Zip Code | 20772 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497355077 | Doris Lynn Perkins | Pharmacist | 5700 Southeast Crain Hwy, Upper Marlboro, MD 20772 | 2020-10-31 |
| 1730790221 | Creative Mind Therapy | Community/Behavioral Health | 12419 Dorsey Ln, Upper Marlboro, MD 20772 | 2020-08-10 |
| 1932727369 | Shaquitta Morton | Behavior Technician | 9440 Marlboro Pike 100, Upper Marlboro, MD 20772 | 2020-07-13 |
| 1760022958 | Keri Daniel | Nurse Practitioner | 9723 Frank Tippett Rd, Upper Marlboro, MD 20772 | 2020-01-15 |
| 1932668134 | Dentistry for Children of Maryland, LLC | Clinic/Center | 9616 Marlboro Pike, Upper Marlboro, MD 20772 | 2019-03-18 |
| 1033673918 | Shonte Renee Drakeford | Nurse Practitioner | 6610 Woodyard Road, Upper Marlboro, MD 20772 | 2019-01-25 |
| 1902391261 | Myenne Hanson | Home Health Aide | 5002 Ashford Dr, Upper Marlboro, MD 20772 | 2018-06-28 |
| 1659884849 | Clement Okehie | Home Health Aide | 13939 Bishops Bequest Rd, Upper Marlboro, MD 20772 | 2017-11-09 |
| 1497264766 | Fatu Barrie | Technician | 11112 Cranfod Drive, Upper Marlboro, MD 20772 | 2017-09-29 |
| 1801315080 | Hope Academy & Nursing Services | Nursing Care | 14101 Christian Street, Upper Marlboro, MD 20772 | 2017-09-19 |
| Find all providers in zip 20772 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477151066 | Evolve Residential, LLC | Substance Abuse Rehabilitation Facility | 486 Lincoln Dr, Glen Burnie, MD 21060-8706 | 2020-10-15 |
| 1841898434 | Evolve Residential, LLC | Substance Abuse Rehabilitation Facility | 394 Washington Ave, Glen Burnie, MD 21060-8712 | 2020-10-15 |
| 1942808050 | Powell Recovery Center, Inc. | Substance Abuse Rehabilitation Facility | 10 S Broadway, Baltimore, MD 21231-1775 | 2020-10-12 |
| 1396343414 | Powell Recovery Center, Inc. | Substance Abuse Rehabilitation Facility | 15 S Broadway, Baltimore, MD 21231-1714 | 2020-10-12 |
| 1801494984 | Evolve Residential, LLC | Substance Abuse Rehabilitation Facility | 8315 Veterans Hwy, Millersville, MD 21108-1421 | 2020-10-12 |
| 1124626296 | Evolve Residential, LLC | Substance Abuse Rehabilitation Facility | 390 Washington Ave, Glen Burnie, MD 21060-8712 | 2020-10-12 |
| 1457968984 | Powell Recovery Center | Substance Abuse Rehabilitation Facility | 22 S Broadway, Baltimore, MD 21231-1711 | 2020-09-29 |
| 1356956676 | The Elysian Fields Optimum Wellness and Mental Health Group, LLC | Substance Abuse Rehabilitation Facility | 2901 Erdman Ave, Baltimore, MD 21213-1139 | 2020-09-14 |
| 1134731284 | Serenity Keepers of Maryland LLC | Substance Abuse Rehabilitation Facility | 3645 Cottage Ave, Baltimore, MD 21215-7725 | 2020-08-20 |
| 1255949392 | Champ House Recovery Inc. | Substance Abuse Rehabilitation Facility | 8655 Normal School Rd, Bowie, MD 20715-3326 | 2020-07-15 |
| Find all providers with the same taxonomy | ||||
| City | UPPER MARLBORO |
| Zip Code | 20772 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.