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General NPI Number Information
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NPI Number | 1801238563
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Entity Type | Organization
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Legal Business Name | SOUTH FLORIDA RECOVERY CENTER
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Dates
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Enumeration Date | 07/23/2013
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Last Update Date | 07/23/2013
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Provider Practice Location Address
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Address Line | 4010 S 57TH AVE STE 103
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City | GREENACRES
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State | FL
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Zip | 33463-4301
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Country | US
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Telephone | 561-275-2001
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Fax |
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Provider Business Mailing Address
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Address Line | 4010 S 57TH AVE STE 103
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City | GREENACRES
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State | FL
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Zip | 33463-4301
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ANGELA IACULLO
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Credential |
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Telephone | 561-270-2361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 10D2060593
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License Number State | FL
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