MEDICARE: NATIONAL DRUG & ALCOHOL RECOVERY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1154546935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL DRUG & ALCOHOL RECOVERY, INC

Provider Business Mailing Address
First Line	:	1349 S INTERNATIONAL PKWY
Second Line	:	SUITE 1401
City	:	LAKE MARY
State	:	FL
Zip	:	32746-1697
Country	:	US
Telephone Number	:	407-705-2564
Fax Number	:	407-829-8521

Provider Business Practice Location Address
First Line	:	1349 S INTERNATIONAL PKWY
Second Line	:	SUITE 1401
City	:	LAKE MARY
State	:	FL
Zip	:	32746-1697
Country	:	US
Telephone Number	:	407-705-2564
Fax Number	:	407-829-8521

Authorized Official
Title or Position	:	VICE-PRESIDENT
Name	:	MR. ROBERT J NIES
Credential	:
Telephone Number	:	407-705-2564

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	08/22/2020

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