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General NPI Number Information
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NPI Number | 1477071116
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Entity Type | Organization
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Legal Business Name | FAITHFUL HOPE RECOVERY, LLC
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Dates
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Enumeration Date | 09/01/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 630 NE 40TH ST
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City | POMPANO BEACH
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State | FL
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Zip | 33064-4321
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Country | US
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Telephone | 561-396-6122
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Fax |
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Provider Business Mailing Address
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Address Line | 11045 NW 71ST CT
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City | PARKLAND
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State | FL
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Zip | 33076-3810
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Country | US
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Telephone | 561-396-6122
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MRS. ELAINE J MACK
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Credential |
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Telephone | 561-396-6122
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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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