Healthcare Provider Details

I. General information

NPI: 1619766961
Provider Name (Legal Business Name): PARKS RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2025
Last Update Date: 05/03/2025
Certification Date: 05/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 CORNELL DR
LAKE WORTH BEACH FL
33460-6208
US

IV. Provider business mailing address

322 CORNELL DR
LAKE WORTH BEACH FL
33460-6208
US

V. Phone/Fax

Practice location:
  • Phone: 561-675-9681
  • Fax:
Mailing address:
  • Phone: 561-675-9681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. NICK PARKS
Title or Position: OWNER
Credential:
Phone: 561-675-9681