Organization
PORT RECOVERY IOP INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOANNE GRANRUTH (OWNER)
(443) 463-8035
Entity
Organization
Contact information
Practice address
8615 RIDGELYS CHOICE DR STE 205, NOTTINGHAM, MD 21236-3028
(443) 869-4909
(443) 869-4928
Mailing address
8615 RIDGELYS CHOICE DR STE 205, NOTTINGHAM, MD 21236-3028
(443) 869-4909
(443) 869-4928
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
—
Other
Enumeration date
04/11/2022
Last updated
04/11/2022
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