MEDICARE: PRR 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

General Provider Information

NPI Number	:	1336696566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRR LLC

Provider Business Mailing Address
First Line	:	4781 N CONGRESS AVE STE 117
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-7941
Country	:	US
Telephone Number	:	561-305-8572
Fax Number	:

Provider Business Practice Location Address
First Line	:	4781 N CONGRESS AVE STE 117
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-7941
Country	:	US
Telephone Number	:	561-305-8572
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	RICHARD WILLIAM BERGIDA
Credential	:
Telephone Number	:	561-305-8572

Provider Enumeration Date	:	09/06/2016
Last Update Date	:	09/06/2016

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Directions to “PRR LLC ” Practice Location

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