MEDICARE: RECOVERY COACHES OF PALM BEACHES 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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1417451907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECOVERY COACHES OF PALM BEACHES LLC

Provider Business Mailing Address
First Line	:	2377 LENA LN
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-7276
Country	:	US
Telephone Number	:	561-253-5478
Fax Number	:

Provider Business Practice Location Address
First Line	:	2377 LENA LN
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-7276
Country	:	US
Telephone Number	:	561-253-5478
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	VITO CAPRI
Credential	:
Telephone Number	:	561-253-5478

Provider Enumeration Date	:	03/20/2018
Last Update Date	:	03/20/2018

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