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General NPI Number Information
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NPI Number | 1912371634
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Entity Type | Organization
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Legal Business Name | FRESH LIFE RECOVERY, LLC
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Dates
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Enumeration Date | 11/18/2015
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Last Update Date | 11/18/2015
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Provider Practice Location Address
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Address Line | 11 S DIXIE HWY
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City | LAKE WORTH
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State | FL
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Zip | 33460-3727
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Country | US
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Telephone | 561-444-2189
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Fax |
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Provider Business Mailing Address
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Address Line | 11 S DIXIE HWY
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City | LAKE WORTH
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State | FL
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Zip | 33460-3727
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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 | BILLING MANAGER
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Name | MELISSA ABREU
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Credential |
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Telephone | 954-415-9373
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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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