Healthcare Provider Details

I. General information

NPI: 1134644537
Provider Name (Legal Business Name): GREGS RECOVERY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2017
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 N UNIVERSITY DRIVE
SUNRISE FL
33322
US

IV. Provider business mailing address

2045 N UNIVERSITY DRIVE
SUNRISE FL
33322
US

V. Phone/Fax

Practice location:
  • Phone: 954-947-8732
  • Fax: 954-947-8736
Mailing address:
  • Phone: 561-213-4103
  • Fax: 954-947-8736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DANIEL S CARO
Title or Position: PARTNER
Credential:
Phone: 954-243-8291