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General NPI Number Information
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NPI Number | 1912445974
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Entity Type | Organization
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Legal Business Name | REBEL RECOVERY FLORIDA INC
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Dates
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Enumeration Date | 02/09/2017
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Last Update Date | 02/09/2017
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Provider Practice Location Address
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Address Line | 1893 PRAIRIE RD
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City | WEST PALM BEACH
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State | FL
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Zip | 33406-6727
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Country | US
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Telephone | 561-508-8388
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Fax |
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Provider Business Mailing Address
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Address Line | 1893 PRAIRIE RD
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City | WEST PALM BEACH
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State | FL
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Zip | 33406-6727
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Country | US
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Telephone | 561-508-8388
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JUSTIN KUNZELMAN
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Credential |
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Telephone | 561-201-0739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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