MEDICARE: IRECOVERY, 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
1	2083A0300X	Addiction Medicine (Preventive Medicine) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376116939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRECOVERY, LLC

Provider Business Mailing Address
First Line	:	5030 CHAMPION BLVD STE G11-535
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33496-2473
Country	:	US
Telephone Number	:	561-235-7683
Fax Number	:	561-464-5501

Provider Business Practice Location Address
First Line	:	301 W BAY ST STE 14208
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32202-5184
Country	:	US
Telephone Number	:	904-664-1454
Fax Number	:	561-464-5501

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	MILDRED CINTRON
Credential	:
Telephone Number	:	561-235-7683

Provider Enumeration Date	:	07/21/2021
Last Update Date	:	09/27/2021

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Directions to “IRECOVERY, LLC ” Practice Location

Language	Start Address	Practice Location

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