Provider Demographics
NPI:1932093523
Name:KINCASA RECOVERY CENTERS LLC
Entity type:Organization
Organization Name:KINCASA RECOVERY CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDUC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-439-2022
Mailing Address - Street 1:118 TURNPIKE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-2156
Mailing Address - Country:US
Mailing Address - Phone:508-439-2022
Mailing Address - Fax:
Practice Address - Street 1:144 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-1802
Practice Address - Country:US
Practice Address - Phone:508-485-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility