Organization
LAKE AVENUE RECOVERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN MARONEY MS, LADC1 (EXECUTIVE DIRECTOR)
(508) 826-6182
Entity
Organization
Contact information
Practice address
425 LAKE AVE N, WORCESTER, MA 01605-2047
(508) 794-4400
Mailing address
38 BRENTWOOD DRIVE, HOLDEN, MA 01520-1932
(508) 826-6182
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
01/09/2020
Last updated
02/12/2024
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