MEDICARE: ARK MOTIVATION RECOVERY PROGRAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1205108388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARK MOTIVATION RECOVERY PROGRAM

Provider Business Mailing Address
First Line	:	18130 NW 49TH AVE
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-2948
Country	:	US
Telephone Number	:	786-925-6066
Fax Number	:

Provider Business Practice Location Address
First Line	:	18130 NW 49TH AVE
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-2948
Country	:	US
Telephone Number	:	786-925-6066
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANTHONY JERRIDO
Credential	:
Telephone Number	:	786-925-6066

Provider Enumeration Date	:	02/03/2012
Last Update Date	:	02/03/2012

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Directions to “ARK MOTIVATION RECOVERY PROGRAM ” Practice Location

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