Healthcare Provider Details

I. General information

NPI: 1568821056
Provider Name (Legal Business Name): GUARDIAN RECOVERY IMMERSION OUTPATIENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 S CONGRESS AVE SUITE 402
DELRAY BEACH FL
33445-7308
US

IV. Provider business mailing address

3333 S CONGRESS AVE SUITE 402
DELRAY BEACH FL
33445-7308
US

V. Phone/Fax

Practice location:
  • Phone: 561-843-5904
  • Fax: 561-877-8041
Mailing address:
  • Phone: 561-877-8232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ROSALIND JOSEPH
Title or Position: AUTHORIZED OFFICAL
Credential:
Phone: 954-607-8075