Healthcare Provider Details

I. General information

NPI: 1669625182
Provider Name (Legal Business Name): CENTRAL FLORIDA RECOVERY CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 TURKEY LAKE RD STE 1-2
ORLANDO FL
32819-4707
US

IV. Provider business mailing address

6900 TURKEY LAKE RD STE 1-1
ORLANDO FL
32819-4707
US

V. Phone/Fax

Practice location:
  • Phone: 407-370-5357
  • Fax: 407-801-5139
Mailing address:
  • Phone: 407-370-9783
  • Fax: 407-370-9784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: HARBINDER SINGH GHULLDU
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 407-370-5357