=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770138745
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RECOVERY SOLUTIONS HEALTH GROUP, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2019
-----------------------------------------------------
Last Update Date | 08/07/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4820 N HIGHWAY 19A STE 1
-----------------------------------------------------
City | MOUNT DORA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32757-2043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-800-4100
-----------------------------------------------------
Fax | 352-602-4062
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4820 N HIGHWAY 19A STE 1
-----------------------------------------------------
City | MOUNT DORA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32757-2043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-800-4100
-----------------------------------------------------
Fax | 352-602-4062
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | PAMELA HAND
-----------------------------------------------------
Credential | LCSW, CAP
-----------------------------------------------------
Telephone | 954-856-0030
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------