Healthcare Provider Details

I. General information

NPI: 1982077608
Provider Name (Legal Business Name): THE PHYSICIANS RECOVERY GROUP LL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2015
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1926 NE 154TH ST
NORTH MIAMI BEACH FL
33162-6022
US

IV. Provider business mailing address

1926 NE 154TH ST
NORTH MIAMI BEACH FL
33162-6022
US

V. Phone/Fax

Practice location:
  • Phone: 305-949-2924
  • Fax: 305-949-9038
Mailing address:
  • Phone: 305-949-2924
  • Fax: 305-949-9038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number268033
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number5912
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberMH9051
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberME37422
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. LEE BARCHAN
Title or Position: OWNER
Credential:
Phone: 305-949-2924