Healthcare Provider Details

I. General information

NPI: 1982145520
Provider Name (Legal Business Name): RECOVERY RESORT GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2017
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15854 BENT CREEK RD
WELLINGTON FL
33414-6382
US

IV. Provider business mailing address

15854 BENT CREEK RD STE 202
WELLINGTON FL
33414-6382
US

V. Phone/Fax

Practice location:
  • Phone: 561-370-4921
  • Fax:
Mailing address:
  • Phone: 561-370-4921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberND 2162
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN 9269366
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberME94575
License Number StateFL

VIII. Authorized Official

Name: MS. DEBRA MOSER
Title or Position: ADMINISTRATIVE DIRECTOR
Credential: RN-C
Phone: 561-370-4921