Healthcare Provider Details

I. General information

NPI: 1649666140
Provider Name (Legal Business Name): ATLANTIC RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14320 MUSTANG TRL
SOUTHWEST RANCHES FL
33330-3508
US

IV. Provider business mailing address

3223 NW 10TH TER STE 608
FORT LAUDERDALE FL
33309-5940
US

V. Phone/Fax

Practice location:
  • Phone: 423-888-8539
  • Fax:
Mailing address:
  • Phone: 469-693-8277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT HASTINGS JR.
Title or Position: CEO
Credential:
Phone: 469-693-8277