Healthcare Provider Details

I. General information

NPI: 1740659200
Provider Name (Legal Business Name): SEACREST RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 E OCEAN AVE
BOYNTON BEACH FL
33435-5005
US

IV. Provider business mailing address

5300 ATLANTIC AVE STE 400
DELRAY BEACH FL
33484-8141
US

V. Phone/Fax

Practice location:
  • Phone: 561-990-2620
  • Fax:
Mailing address:
  • Phone: 561-990-2620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number5001
License Number StateFL

VIII. Authorized Official

Name: MR. JOSH FENSTER
Title or Position: CEO/OWNER
Credential:
Phone: 561-990-2620