Healthcare Provider Details

I. General information

NPI: 1235536491
Provider Name (Legal Business Name): PEAK RECOVERY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2014
Last Update Date: 12/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4895 WINDWARD PASSAGE DR SUITE 6
BOYNTON BEACH FL
33436-7741
US

IV. Provider business mailing address

4895 WINDWARD PASSAGE DR SUITE 6
BOYNTON BEACH FL
33436-7741
US

V. Phone/Fax

Practice location:
  • Phone: 561-877-8753
  • Fax:
Mailing address:
  • Phone: 561-877-8753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JACOB PISTOR PISTOR
Title or Position: OFFICE MANAGER
Credential:
Phone: 561-877-8753