Healthcare Provider Details

I. General information

NPI: 1437992666
Provider Name (Legal Business Name): RECLAMATION CENTER PCP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2024
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 S SEACREST BLVD STE 204
BOYNTON BEACH FL
33435-7944
US

IV. Provider business mailing address

2900 W CYPRESS CREEK RD STE 8
FORT LAUDERDALE FL
33309-1715
US

V. Phone/Fax

Practice location:
  • Phone: 954-343-6552
  • Fax: 754-255-7455
Mailing address:
  • Phone: 954-614-8755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA DENIS
Title or Position: OWNER
Credential:
Phone: 954-614-8755