Provider Demographics
NPI:1699121343
Name:ADDICTION RECOVERY NETWORK LLC
Entity type:Organization
Organization Name:ADDICTION RECOVERY NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOEHS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-783-5581
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-0247
Mailing Address - Country:US
Mailing Address - Phone:315-783-5581
Mailing Address - Fax:
Practice Address - Street 1:428 WASHINGTON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-4832
Practice Address - Country:US
Practice Address - Phone:315-405-8038
Practice Address - Fax:315-405-8999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-12
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty