Provider Demographics
NPI:1386201713
Name:MOUNTAINS EDGE RECOVERY CENTER LLC
Entity type:Organization
Organization Name:MOUNTAINS EDGE RECOVERY CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-777-0467
Mailing Address - Street 1:310 SUGAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18470
Mailing Address - Country:US
Mailing Address - Phone:570-679-2459
Mailing Address - Fax:570-413-0423
Practice Address - Street 1:310 SUGAR HILL RD
Practice Address - Street 2:
Practice Address - City:UNION DALE
Practice Address - State:PA
Practice Address - Zip Code:18470-7397
Practice Address - Country:US
Practice Address - Phone:772-252-1235
Practice Address - Fax:772-252-1235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-21
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility