Provider Demographics
NPI:1053135632
Name:GOSPORT RECOVERY LLC
Entity type:Organization
Organization Name:GOSPORT RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORLINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-971-1631
Mailing Address - Street 1:3960 SOUTHEASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-1500
Mailing Address - Country:US
Mailing Address - Phone:317-947-0233
Mailing Address - Fax:
Practice Address - Street 1:27 S 7TH ST
Practice Address - Street 2:
Practice Address - City:GOSPORT
Practice Address - State:IN
Practice Address - Zip Code:47433-7010
Practice Address - Country:US
Practice Address - Phone:317-947-0233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility