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General NPI Number Information
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NPI Number | 1811390867
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Entity Type | Organization
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Legal Business Name | PROACTIVE RECOVERY CENTER, LLC
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Dates
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Enumeration Date | 10/06/2014
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Last Update Date | 11/22/2016
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Provider Practice Location Address
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Address Line | 500 GULFSTREAM BLVD STE 105
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City | DELRAY BEACH
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State | FL
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Zip | 33483-6142
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Country | US
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Telephone | 844-763-9968
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Fax | 877-281-1665
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Provider Business Mailing Address
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Address Line | 500 GULFSTREAM BLVD STE 105
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City | DELRAY BEACH
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State | FL
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Zip | 33483-6142
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Country | US
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Telephone | 844-763-9968
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Fax | 877-281-1665
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Authorized Official
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Title or Position | MANAGER
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Name | MR. MUSTAFA SANDHU
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Credential |
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Telephone | 201-600-2843
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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 | 1550AD719901
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License Number State | FL
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