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General NPI Number Information
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NPI Number | 1699295303
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Entity Type | Organization
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Legal Business Name | REFORM RECOVERY, INC.
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Dates
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Enumeration Date | 06/23/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 233B N CAUSEWAY
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32169-5239
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Country | US
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Telephone | 386-402-4717
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Fax |
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Provider Business Mailing Address
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Address Line | 233B N CAUSEWAY
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32169-5239
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Country | US
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Telephone | 386-402-4717
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREW DYKES
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Credential |
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Telephone | 386-402-4717
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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 | 6401
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License Number State | FL
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