Healthcare Provider Details

I. General information

NPI: 1184306433
Provider Name (Legal Business Name): RECOVERY FOR LIFE TREATMENT AND WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1359 E SAMPLE RD
POMPANO BEACH FL
33064
US

IV. Provider business mailing address

1359 E SAMPLE RD
POMPANO BEACH FL
33064-6278
US

V. Phone/Fax

Practice location:
  • Phone: 305-766-9667
  • Fax:
Mailing address:
  • Phone: 305-766-9667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: ANNAIZA SHARMA
Title or Position: OWNER
Credential:
Phone: 305-766-9667