Provider Demographics
NPI:1225920408
Name:LOST SOULS RECOVERY, LLC
Entity type:Organization
Organization Name:LOST SOULS RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NADEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:BASHIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-622-9101
Mailing Address - Street 1:130 WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:CLEMENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-4159
Mailing Address - Country:US
Mailing Address - Phone:570-622-9101
Mailing Address - Fax:570-622-9102
Practice Address - Street 1:130 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:CLEMENTON
Practice Address - State:NJ
Practice Address - Zip Code:08021-4159
Practice Address - Country:US
Practice Address - Phone:570-622-9101
Practice Address - Fax:570-622-9102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty