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NPI Code Detail

MEDICARE: RECOVERY VILLAGE AT PALMER LAKE, LLC

MEDICARE: RECOVERY VILLAGE AT PALMER LAKE, LLC
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
1320800000XMental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number : 1336097120
Entity Type Code : Organization
Provider Name (Legal Business Name) : RECOVERY VILLAGE AT PALMER LAKE, LLC
Provider Business Mailing Address
First Line : 2200 N COMMERCE PKWY STE 200
Second Line :
City : WESTON
State : FL
Zip : 33326-3258
Country : US
Telephone Number : 305-785-5520
Fax Number : 888-919-4431
Provider Business Practice Location Address
First Line : 443 HIGHWAY 105
Second Line :
City : PALMER LAKE
State : CO
Zip : 80133-9003
Country : US
Telephone Number : 305-785-5520
Fax Number : 888-919-4431
Authorized Official
Title or Position : VP CONTRACTING & LICENSING
Name : BELINA SURUJON
Credential :
Telephone Number : 305-785-5520
Provider Enumeration Date : 03/18/2026
Last Update Date : 03/18/2026

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Directions to “RECOVERY VILLAGE AT PALMER LAKE, LLC ” Practice Location

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