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General NPI Number Information
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NPI Number | 1548517089
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Entity Type | Organization
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Legal Business Name | REAL LIFE RECOVERY DELRAY LLC
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Dates
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Enumeration Date | 08/14/2012
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Last Update Date | 06/01/2015
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Provider Practice Location Address
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Address Line | 413 NE 3RD ST
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City | DELRAY BEACH
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State | FL
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Zip | 33483-4526
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Country | US
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Telephone | 561-705-0150
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Fax | 561-501-5768
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Provider Business Mailing Address
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Address Line | 413 NE 3RD ST
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City | DELRAY BEACH
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State | FL
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Zip | 33483-4526
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Country | US
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Telephone | 561-705-0150
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Fax | 561-501-5768
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Authorized Official
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Title or Position | CEO
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Name | ERIC SNYDER
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Credential |
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Telephone | 856-534-6997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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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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