Healthcare Provider Details

I. General information

NPI: 1174022404
Provider Name (Legal Business Name): HARMONY RIDGE RECOVERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 CHAMBERS CIRCLE DRIVE
WALKER WV
26180
US

IV. Provider business mailing address

675 WEST INDIANTOWN ROAD SUITE 103
JUPITER FL
33458
US

V. Phone/Fax

Practice location:
  • Phone: 888-771-8372
  • Fax:
Mailing address:
  • Phone: 561-427-6776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number452
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number452
License Number StateWV

VIII. Authorized Official

Name: MR. RICHARD SABELLA
Title or Position: OWNER
Credential:
Phone: 561-427-6776