Healthcare Provider Details

I. General information

NPI: 1790163319
Provider Name (Legal Business Name): SPENCER RECOVERY CENTERS FLORIDA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 SAN MARCO AVE
ST AUGUSTINE FL
32084-2733
US

IV. Provider business mailing address

PO BOX 9296
LAGUNA BEACH CA
92652-7261
US

V. Phone/Fax

Practice location:
  • Phone: 800-334-0394
  • Fax: 949-313-5222
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number0755AD237401
License Number StateFL

VIII. Authorized Official

Name: CHARLES FRANCIS KANUTE
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 949-315-9225