MEDICARE: REGARD RECOVERY RESIDENTIAL TREATMENT OF FLORIDA, 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	261QM0850X	Adult Mental Health Clinic/Center
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1047725	OTHER	FL	DCF - OP
2	1047729	OTHER	FL	DCF - DAY OR NIGHT TREATMENT WITH COMMUNITY HOUSING
3	1047728	OTHER	FL	DCF - IOP

General Provider Information

NPI Number	:	1508448663
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGARD RECOVERY RESIDENTIAL TREATMENT OF FLORIDA, LLC

Provider Business Mailing Address
First Line	:	6460 NW 5TH WAY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-6112
Country	:	US
Telephone Number	:	954-771-2091
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 SW 12TH AVE STE 110
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33069-3595
Country	:	US
Telephone Number	:	570-332-3060
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	LISA MICHELETTI
Credential	:	LMHC
Telephone Number	:	570-332-3060

Provider Enumeration Date	:	04/27/2021
Last Update Date	:	10/12/2023

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