Healthcare Provider Details

I. General information

NPI: 1710362272
Provider Name (Legal Business Name): RECOVERY BOOT CAMP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 07/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 SW 1ST ST
DELRAY BEACH FL
33444-2501
US

IV. Provider business mailing address

85 SW 5TH AVE SUITE 101
DELRAY BEACH FL
33444-2511
US

V. Phone/Fax

Practice location:
  • Phone: 561-563-8888
  • Fax:
Mailing address:
  • Phone: 561-563-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY SCHNELLENBERGER
Title or Position: OWNER
Credential:
Phone: 561-251-2770