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General NPI Number Information
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NPI Number | 1801299334
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Entity Type | Organization
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Legal Business Name | RECO INTENSIVE, LLC
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Dates
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Enumeration Date | 09/29/2014
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Last Update Date | 09/29/2014
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Provider Practice Location Address
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Address Line | 1200 NW 17TH AVE SUITE # 14
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City | DELRAY BEACH
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State | FL
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Zip | 33445-2503
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Country | US
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Telephone | 561-808-7986
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Fax |
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Provider Business Mailing Address
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Address Line | 1605 RENAISSANCE COMMONS BLVD APT 537
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-8289
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Country | US
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Telephone | 561-808-7986
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Fax |
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Authorized Official
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Title or Position | OWNER, CEO
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Name | DAVID NIKNAFS
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Credential |
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Telephone | 678-207-9575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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