MEDICARE: PALM TREE RECOVERY 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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1184983041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALM TREE RECOVERY LLC

Provider Business Mailing Address
First Line	:	2411 QUANTUM BLVD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-8612
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2411 QUANTUM BLVD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-8612
Country	:	US
Telephone Number	:	561-733-0878
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SCOTT TOBIN
Credential	:
Telephone Number	:	561-733-0878

Provider Enumeration Date	:	05/14/2012
Last Update Date	:	05/14/2012

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