1265970263 NPI number — GHR CENTER FOR OPIOID ADDICTION TREATMENT AND RECOVERY LLC

Table of content: (NPI 1265970263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265970263 NPI number — GHR CENTER FOR OPIOID ADDICTION TREATMENT AND RECOVERY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GHR CENTER FOR OPIOID ADDICTION TREATMENT AND RECOVERY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE GHR CENTER FOR ADDICTION TREATMENT AND RECOVERY
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265970263
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
850 TIDEWATER DR STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23504-3300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-209-2776
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 TIDEWATER DR STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23504-3300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-333-6992
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/09/2017

Additional Information

Authorized Official

Authorized Official Last Name:
KIRVIN
Authorized Official First Name:
SHANI
Authorized Official Middle Name:
Authorized Official Title or Position:
OPERATIONS MANAGER
Authorized Official Telephone Number:
757-333-6992

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RA0401X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084A0401X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1811905250 . This is a "NPI FOR LAWRENCE ROSS PHD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0101222715 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1881870442 . This is a "GENE GERMANO MD INDIVIDUAL NPI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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