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General NPI Number Information
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NPI Number | 1477013696
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Entity Type | Organization
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Legal Business Name | PALM COAST RECOVERY CENTER LLC
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Dates
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Enumeration Date | 03/22/2019
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Last Update Date | 05/18/2022
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Provider Practice Location Address
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Address Line | 160 CYPRESS POINT PKWY
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City | PALM COAST
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State | FL
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Zip | 32164-8433
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Country | US
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Telephone | 386-986-6498
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Fax |
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Provider Business Mailing Address
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Address Line | 160 CYPRESS POINT PKWY
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City | PALM COAST
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State | FL
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Zip | 32164-8433
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Country | US
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Telephone | 386-986-6498
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | ZACHARY MILLER
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Credential | MCAP
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Telephone | 386-986-6498
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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