Healthcare Provider Details

I. General information

NPI: 1245153923
Provider Name (Legal Business Name): CLEAN & SOBER RECOVERY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 THELMA AVE
JUPITER FL
33458-8091
US

IV. Provider business mailing address

5829 CORPORATE WAY
WEST PALM BEACH FL
33407-2021
US

V. Phone/Fax

Practice location:
  • Phone: 561-480-4335
  • Fax: 561-516-8200
Mailing address:
  • Phone: 561-480-4335
  • Fax: 561-516-8200

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: VERONICA HERNANDEZ
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 954-203-3584