Provider Demographics
NPI:1265970263
Name:GHR CENTER FOR OPIOID ADDICTION TREATMENT AND RECOVERY LLC
Entity type:Organization
Organization Name:GHR CENTER FOR OPIOID ADDICTION TREATMENT AND RECOVERY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANI
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-333-6992
Mailing Address - Street 1:850 TIDEWATER DR STE A
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-3300
Mailing Address - Country:US
Mailing Address - Phone:757-209-2776
Mailing Address - Fax:
Practice Address - Street 1:850 TIDEWATER DR STE A
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-3300
Practice Address - Country:US
Practice Address - Phone:757-333-6992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207R00000X, 2084A0401X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1811905250OtherNPI FOR LAWRENCE ROSS PHD
VA0101222715OtherMEDICAL LICENSE
VA1881870442OtherGENE GERMANO MD INDIVIDUAL NPI
VA023012P55Medicare Oscar/Certification
VA023012P55Medicare Oscar/Certification