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General NPI Number Information
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NPI Number | 1275981243
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Entity Type | Organization
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Legal Business Name | COCONUT GROVE RECOVERY LLC
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Dates
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Enumeration Date | 05/31/2016
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 15291 NW 60TH AVE STE 200-201
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City | MIAMI LAKES
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State | FL
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Zip | 33014-8590
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Country | US
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Telephone | 952-234-2469
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Fax | 954-204-0464
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Provider Business Mailing Address
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Address Line | 15291 NW 60TH AVE STE 200/201
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City | MIAMI LAKES
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State | FL
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Zip | 33014-8590
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Country | US
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Telephone | 954-234-2469
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Fax | 954-204-0464
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Authorized Official
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Title or Position | OFFICE MGR
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Name | CATHY A PICILLO
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Credential |
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Telephone | 954-234-2469
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME43252
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License Number State | FL
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