Healthcare Provider Details

I. General information

NPI: 1548517089
Provider Name (Legal Business Name): REAL LIFE RECOVERY DELRAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 06/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 NE 3RD ST
DELRAY BEACH FL
33483-4526
US

IV. Provider business mailing address

413 NE 3RD ST
DELRAY BEACH FL
33483-4526
US

V. Phone/Fax

Practice location:
  • Phone: 561-705-0150
  • Fax: 561-501-5768
Mailing address:
  • Phone: 561-705-0150
  • Fax: 561-501-5768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateFL

VIII. Authorized Official

Name: ERIC SNYDER
Title or Position: CEO
Credential:
Phone: 856-534-6997