Healthcare Provider Details

I. General information

NPI: 1992378558
Provider Name (Legal Business Name): IRECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 E WASHINGTON ST STE 200-A20
ORLANDO FL
32801-2354
US

IV. Provider business mailing address

5030 CHAMPION BLVD STE G11-535
BOCA RATON FL
33496-2473
US

V. Phone/Fax

Practice location:
  • Phone: 407-743-7797
  • Fax: 561-464-5501
Mailing address:
  • Phone: 561-235-7683
  • Fax: 561-464-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MILDRED CINTRON
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 561-235-7683