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General NPI Number Information
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NPI Number | 1003527581
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Entity Type | Organization
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Legal Business Name | POLK FOR RECOVERY, INC.
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Dates
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Enumeration Date | 12/06/2022
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Last Update Date | 12/06/2022
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Provider Practice Location Address
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Address Line | 244 AVENUE D SW
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City | WINTER HAVEN
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State | FL
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Zip | 33880-3423
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Country | US
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Telephone | 863-288-6522
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Fax |
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Provider Business Mailing Address
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Address Line | 3031 EAGLE HAVEN DR
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City | WINTER HAVEN
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State | FL
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Zip | 33880-5208
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Country | US
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Telephone | 863-288-6522
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. CRAIG PICKOS
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Credential | CRSS
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Telephone | 863-288-6522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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