Organization
RECOVERY 180 VIRGINIA LLC
Active
Parent organization
RECOVERY 180 VIRGINIA LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
RECOVERY 180 VIRGINIA LLC
Authorized official
JESSIE COSTLEY (CREDENTIALING SPECIALIST)
(443) 839-6928
Entity
Organization
Contact information
Practice address
6791 JAMES MADISON HWY, WARRENTON, VA 20187-9534
(443) 289-8606
Mailing address
1100 BUSINESS PKWY S STE 1, WESTMINSTER, MD 21157-3048
(443) 839-6928
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8228-02-033
FACILITY LICENSE
VA
01
—
8228-02-035
FACILITY LICENSE
VA
Enumeration date
01/30/2024
Last updated
01/30/2024
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