Organization
LIBERTY BAY RECOVERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE JARVIE (VP, TREASURER)
(214) 379-3300
Entity
Organization
Contact information
Practice address
343 FOREST AVE, PORTLAND, ME 04101-2006
(207) 772-9800
(207) 536-1511
Mailing address
343 FOREST AVE, PORTLAND, ME 04101-2006
(207) 772-9800
(207) 536-1511
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
684958
ME
324500000X
Substance Abuse Rehabilitation Facility
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Other
Enumeration date
04/07/2015
Last updated
09/04/2024
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