Healthcare Provider Details

I. General information

NPI: 1538018973
Provider Name (Legal Business Name): RECOVERING CHAMPIONS OPERATING SUBSIDIARY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 BRICK KILN RD
TEATICKET MA
02536-5651
US

IV. Provider business mailing address

2925 10TH AVE N
PALM SPRINGS FL
33461-3000
US

V. Phone/Fax

Practice location:
  • Phone: 305-361-9115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TARA GURNEY
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 561-517-3400