Healthcare Provider Details

I. General information

NPI: 1912872185
Provider Name (Legal Business Name): PRINCIPLES RECOVERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2025
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 S UNIVERSITY DR STE 203
DAVIE FL
33328-3811
US

IV. Provider business mailing address

4343 S STATE ROAD 7 STE 101
DAVIE FL
33314-4009
US

V. Phone/Fax

Practice location:
  • Phone: 954-738-8146
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DUSTIN JOHNSON
Title or Position: CEO
Credential:
Phone: 561-816-9023