MEDICARE: INTERVENTIONS RECOVERY TREATMENT CENTER

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	324500000X	Substance Abuse Rehabilitation Facility		FL

General Provider Information

NPI Number	:	1255728630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERVENTIONS RECOVERY TREATMENT CENTER

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	:	754-200-5155

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	:	754-200-5155

Authorized Official
Title or Position	:	CEO
Name	:	MR. PAUL K SOHR
Credential	:	LMHC CAP ICADC
Telephone Number	:	754-227-8937

Provider Enumeration Date	:	04/23/2015
Last Update Date	:	04/23/2015

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