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General NPI Number Information
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NPI Number | 1851680607
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Entity Type | Organization
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Legal Business Name | FOUNTAINS RECOVERY, LLC
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Dates
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Enumeration Date | 04/01/2011
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Last Update Date | 04/01/2011
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Provider Practice Location Address
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Address Line | 798 S FEDERAL HWY STE 200
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City | BOCA RATON
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State | FL
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Zip | 33432-6162
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Country | US
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Telephone | 561-955-8575
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Fax | 561-955-8715
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Provider Business Mailing Address
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Address Line | 798 S FEDERAL HWY STE 200
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City | BOCA RATON
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State | FL
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Zip | 33432-6162
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Country | US
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Telephone | 561-955-8575
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Fax | 561-955-8715
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Authorized Official
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Title or Position | DIR. OF OPERATIONS
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Name | MS. VAN JONES
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Credential | MS, EDD., CMHP
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Telephone | 561-955-8575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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