Healthcare Provider Details

I. General information

NPI: 1215362587
Provider Name (Legal Business Name): REFLECTIONS OF RECOVERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 STATE RD. 19A SUITE #6
MT. DORA FL
32757
US

IV. Provider business mailing address

4400 STATE RD 19A #6
MOUNT DORA FL
32757
US

V. Phone/Fax

Practice location:
  • Phone: 954-856-0030
  • Fax:
Mailing address:
  • Phone: 352-308-8281
  • Fax: 352-602-4310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberSW 10626
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberSW 10626
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateFL

VIII. Authorized Official

Name: MARY MEYER
Title or Position: BILLING ADMINISTRATOR
Credential:
Phone: 954-366-3244