=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215808985
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RECOVERY UNPLUGGED PENNSYLVANIA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2025
-----------------------------------------------------
Last Update Date | 09/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 915 MIDDLE RIVER DR STE 114
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33304-3586
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-368-0888
-----------------------------------------------------
Fax | 954-212-2227
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 915 MIDDLE RIVER DR STE 114
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33304-3586
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-368-0888
-----------------------------------------------------
Fax | 954-212-2227
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP, PAYOR SERVICES
-----------------------------------------------------
Name | JESSICA ARBAUGH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-368-0888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------