MEDICARE: RECOVERY INSTITUTE OF THE SOUTH EAST P.A.

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1881014405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECOVERY INSTITUTE OF THE SOUTH EAST P.A.

Provider Business Mailing Address
First Line	:	700 E ATLANTIC BLVD
Second Line	:	SUITE#201
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-6353
Country	:	US
Telephone Number	:	754-307-5404
Fax Number	:	866-381-0360

Provider Business Practice Location Address
First Line	:	700 E ATLANTIC BLVD
Second Line	:	SUITE#201
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-6353
Country	:	US
Telephone Number	:	754-307-5404
Fax Number	:	866-381-0360

Authorized Official
Title or Position	:	OWNER
Name	:	BET SHADDINGER
Credential	:
Telephone Number	:	754-307-5404

Provider Enumeration Date	:	04/22/2014
Last Update Date	:	08/05/2016

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