Healthcare Provider Details

I. General information

NPI: 1932559705
Provider Name (Legal Business Name): SOUND RECOVERY SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 07/21/2022
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 TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number5001
License Number StateFL

VIII. Authorized Official

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