Healthcare Provider Details

I. General information

NPI: 1710558713
Provider Name (Legal Business Name): VERO BEACH RECOVERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 03/09/2023
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 17TH ST STE M
VERO BEACH FL
32960-5686
US

IV. Provider business mailing address

333 17TH ST STE M
VERO BEACH FL
32960-5686
US

V. Phone/Fax

Practice location:
  • Phone: 215-356-2043
  • Fax:
Mailing address:
  • Phone: 772-584-3083
  • Fax: 772-218-3003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. THERESA A PRESCOTT
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: DO
Phone: 215-356-2043