Healthcare Provider Details

I. General information

NPI: 1730446725
Provider Name (Legal Business Name): OPIATE RECOVERY CENTER ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 04/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 EAST FORT KING ST. SUITE C
OCALA FL
34471-2566
US

IV. Provider business mailing address

2215 EAST FORT KING ST. SUITE C
OCALA FL
34471-2566
US

V. Phone/Fax

Practice location:
  • Phone: 352-351-0867
  • Fax: 352-351-3263
Mailing address:
  • Phone: 352-351-0867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberA41544
License Number StateFL

VIII. Authorized Official

Name: MRS. SALLY ANN ROUMELIS-NICHOLS
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 352-351-0867