Organization · NPI-2

Access Recovery LLC

Clinic/Center, Methadone Clinic · Bridgeport, CT

NPI number1689491128
StatusActive
Last updated in NPPESSep 25, 2024

Details

NPI
1689491128
Entity type
Organization (NPI-2)
Legal business name
Access Recovery LLC
Organization subpart
No
Enumeration date
Sep 25, 2024
Certification date
Sep 25, 2024
Last updated
Sep 25, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QM2800X Clinic/Center, Methadone Clinic––Yes
207QA0401X Family Medicine, Addiction Medicine––
207RA0401X Internal Medicine, Addiction Medicine––
261QM0850X Clinic/Center, Adult Mental Health––
261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder––

Practice location

4675 Main St
Bridgeport, CT 06606-1813

Phone 203-372-3333 · Fax 203-374-7515

Mailing address

4675 Main St
Bridgeport, CT 06606-1813

Phone 203-372-3333 · Fax 203-374-7515

Authorized official

Ebenezer Adekunle Kolade
Member
2038037428

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