Healthcare Provider Details

I. General information

NPI: 1275457855
Provider Name (Legal Business Name): ELITE RECOVERY FL,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7711 BAYMEADOWS RD E STE 4
JACKSONVILLE FL
32256-9110
US

IV. Provider business mailing address

7711 BAYMEADOWS RD E STE 4
JACKSONVILLE FL
32256-9110
US

V. Phone/Fax

Practice location:
  • Phone: 904-889-1395
  • Fax:
Mailing address:
  • Phone: 904-889-1395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. DWAYNE JOHNSON
Title or Position: OWNER
Credential:
Phone: 904-889-1395