| Port Recovery Iop Inc. | |
|
8615 Ridgelys Choice Dr Ste 205 Nottingham MD 21236-3028 | |
| (443) 869-4909 | |
| (443) 869-4928 |
| Full Name | Port Recovery Iop Inc. |
|---|---|
| Speciality | Counselor |
| Location | 8615 Ridgelys Choice Dr Ste 205, Nottingham, Maryland |
| Authorized Official Name and Position | Joanne Granruth (OWNER) |
| Authorized Official Contact | 4105348735 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Port Recovery Iop Inc. 8615 Ridgelys Choice Dr Ste 205 Nottingham MD 21236-3028 Ph: (443) 869-4909 | Port Recovery Iop Inc. 8615 Ridgelys Choice Dr Ste 205 Nottingham MD 21236-3028 Ph: (443) 869-4909 |
| NPI Number | 1578026464 |
|---|---|
| Provider Enumeration Date | 04/09/2019 |
| Last Update Date | 04/09/2019 |
| Medicare PECOS PAC ID | 2961650551 |
|---|---|
| Medicare Enrollment ID | O20190919000034 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578026464 | NPI | - | NPPES |
| Provider Name | Randal Alan Steele |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811969835 PECOS PAC ID: 0749311892 Enrollment ID: I20110406000830 |
| Provider Name | Terri S Nicholson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144659400 PECOS PAC ID: 8426287350 Enrollment ID: I20140218001576 |
| Provider Name | Elaine Cook |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174504047 PECOS PAC ID: 9032115167 Enrollment ID: I20140728000166 |
| Provider Name | Carol L Garey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366876690 PECOS PAC ID: 4385917772 Enrollment ID: I20170906003833 |
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