Healthcare Provider Details

I. General information

NPI: 1912376088
Provider Name (Legal Business Name): WHOLE LIFE RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S CONGRESS AVE STE 102
BOYNTON BEACH FL
33426-9041
US

IV. Provider business mailing address

3200 S CONGRESS AVE STE 102
BOYNTON BEACH FL
33426-9041
US

V. Phone/Fax

Practice location:
  • Phone: 561-289-7900
  • Fax:
Mailing address:
  • Phone: 561-289-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES KIGAR
Title or Position: CEO
Credential:
Phone: 561-289-7900