MEDICARE: INTERVENTIONS RECOVERY COUNSELING CENTER LLC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	5753	FL
2	251S00000X	Community/Behavioral Health Agency
3	101YM0800X	Mental Health Counselor	MH11818	FL

General Provider Information

NPI Number	:	1184040321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERVENTIONS RECOVERY COUNSELING CENTER LLC

Provider Business Mailing Address
First Line	:	1800 SE 3RD AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-2877
Country	:	US
Telephone Number	:	754-227-8937
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 SE 3RD AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-2877
Country	:	US
Telephone Number	:	754-227-8937
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	PAUL KEVIN SOHR
Credential	:	M.S., C.A.P,, ICADC
Telephone Number	:	754-227-8937

Provider Enumeration Date	:	03/12/2014
Last Update Date	:	03/12/2014

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