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General NPI Number Information
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NPI Number | 1427724475
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Entity Type | Organization
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Legal Business Name | SEACREST RECOVERY CENTER CINCINNATI, LLC
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Dates
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Enumeration Date | 08/19/2021
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 1 TRIANGLE PARK DR STE 100
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City | CINCINNATI
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State | OH
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Zip | 45246-3423
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Country | US
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Telephone | 561-990-2620
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Fax |
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Provider Business Mailing Address
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Address Line | 5300 ATLANTIC AVE STE 400
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City | DELRAY BEACH
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State | FL
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Zip | 33484-8141
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Country | US
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Telephone | 954-415-3608
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JARED PRUZAN
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Credential |
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Telephone | 954-415-3608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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