Healthcare Provider Details

I. General information

NPI: 1760729669
Provider Name (Legal Business Name): THE RECOVERY VILLAGE AT UMATILLA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2013
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 UMATILLA BLVD
UMATILLA FL
32784-8418
US

IV. Provider business mailing address

1 FINANCIAL PLZ STE 1800
FT LAUDERDALE FL
33394-0011
US

V. Phone/Fax

Practice location:
  • Phone: 954-746-8232
  • Fax: 954-746-8981
Mailing address:
  • Phone: 754-300-3120
  • Fax: 888-919-4431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: BELINA SURUJON
Title or Position: LICENSING & CONTRACTING DIRECTOR
Credential:
Phone: 305-785-5520