Healthcare Provider Details

I. General information

NPI: 1093103251
Provider Name (Legal Business Name): SOUND RECOVERY SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2014
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 N FEDERAL HWY SUITE 105
DELRAY BEACH FL
33483-6147
US

IV. Provider business mailing address

2512 N FEDERAL HWY SUITE 105
DELRAY BEACH FL
33483-6147
US

V. Phone/Fax

Practice location:
  • Phone: 857-225-1998
  • Fax:
Mailing address:
  • Phone: 857-225-1998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number5047165841301
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number5047165841301
License Number StateFL

VIII. Authorized Official

Name: CHARLES JARVIS
Title or Position: OWNER
Credential:
Phone: 857-225-1998