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General NPI Number Information
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NPI Number | 1518320258
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Entity Type | Organization
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Legal Business Name | GREENWAY RECOVERY, LLC
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Dates
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Enumeration Date | 03/31/2016
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 230 E OCEAN AVE
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City | LANTANA
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State | FL
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Zip | 33462-3236
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Country | US
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Telephone | 561-469-6472
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Fax |
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Provider Business Mailing Address
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Address Line | 230 E OCEAN AVE
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City | LANTANA
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State | FL
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Zip | 33462-3236
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Country | US
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Telephone | 561-469-6472
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF ACCOUNT MANAGEMENT
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Name | JOHN RICHARDS
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Credential |
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Telephone | 561-413-9860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 5001
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License Number State | FL
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