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NPI Code Detail

MEDICARE: REVOLUTION RECOVERY CENTER, INC.

MEDICARE: REVOLUTION RECOVERY CENTER, 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
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number : 1205686284
Entity Type Code : Organization
Provider Name (Legal Business Name) : REVOLUTION RECOVERY CENTER, INC.
Provider Business Mailing Address
First Line : 1111 HYPOLUXO RD STE 207
Second Line :
City : LANTANA
State : FL
Zip : 33462-4271
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 415 S FEDERAL HWY
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33435-4931
Country : US
Telephone Number : 215-896-7859
Fax Number :
Authorized Official
Title or Position : CEO
Name : ANTHONY MARTINO
Credential :
Telephone Number : 215-896-7859
Provider Enumeration Date : 03/25/2024
Last Update Date : 03/25/2024

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