=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083116420
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTH MIAMI RECOVERY, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2018
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7520 SW 57TH AVE STE K
-----------------------------------------------------
City | SOUTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33143-5330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-661-0055
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7520 S RED RD STE E1
-----------------------------------------------------
City | SOUTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33143-5330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-661-0055
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. HOWARD LERNER
-----------------------------------------------------
Credential | CAP
-----------------------------------------------------
Telephone | 305-733-9655
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number | 1301
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------