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General NPI Number Information
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NPI Number | 1700245719
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Entity Type | Organization
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Legal Business Name | SOUTH OCEAN RECOVERY
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Dates
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Enumeration Date | 02/18/2016
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Last Update Date | 02/18/2016
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Provider Practice Location Address
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Address Line | 1732 S CONGRESS AVE STE 354
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City | PALM SPRINGS
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State | FL
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Zip | 33461-2140
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Country | US
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Telephone | 561-425-5343
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Fax |
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Provider Business Mailing Address
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Address Line | 7731 N MILITARY TRL STE 1
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City | WEST PALM BEACH
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State | FL
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Zip | 33410-7430
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Country | US
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Telephone | 561-425-5343
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Fax |
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Authorized Official
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Title or Position | SENIOR CREDENTIALING SPECIALIST
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Name | KELI KORNMILLER
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Credential |
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Telephone | 561-672-8345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 1550AD332201
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License Number State | FL
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