Provider Demographics
NPI:1023289048
Name:DISCOVERY HOUSE RF
Entity type:Organization
Organization Name:DISCOVERY HOUSE RF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:F
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-780-2300
Mailing Address - Street 1:66 PAVILION AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-1522
Mailing Address - Country:US
Mailing Address - Phone:401-780-2300
Mailing Address - Fax:401-780-2397
Practice Address - Street 1:4855 E STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2274
Practice Address - Country:US
Practice Address - Phone:815-484-0900
Practice Address - Fax:815-484-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA72600001A261QM2800X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone