Provider Demographics
NPI:1194246371
Name:BODHI RECOVERY INC
Entity type:Organization
Organization Name:BODHI RECOVERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:RN-BC, LICENSED PSYC
Authorized Official - Phone:724-322-2229
Mailing Address - Street 1:21 YOST BLVD
Mailing Address - Street 2:COST COMMONS #5 SUITE 301
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15221-5283
Mailing Address - Country:US
Mailing Address - Phone:412-735-9197
Mailing Address - Fax:412-291-2765
Practice Address - Street 1:21 YOST BLVD
Practice Address - Street 2:COST COMMONS #5 SUITE 301
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15221-5283
Practice Address - Country:US
Practice Address - Phone:412-735-9197
Practice Address - Fax:412-291-2765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty