Healthcare Provider Details

I. General information

NPI: 1760981260
Provider Name (Legal Business Name): PANAMA CITY SPRINGS & RECOVERY CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2018
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 W 19TH ST
PANAMA CITY FL
32405-4104
US

IV. Provider business mailing address

3562 FOUR OAKS BLVD
TALLAHASSEE FL
32311-3308
US

V. Phone/Fax

Practice location:
  • Phone: 850-567-6164
  • Fax:
Mailing address:
  • Phone: 850-567-6164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. WARREN PEARSON
Title or Position: CEO
Credential: JD
Phone: 850-567-6164