MEDICARE: RECOVERY IN THE LIGHT

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
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center		FL

General Provider Information

NPI Number	:	1457757833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECOVERY IN THE LIGHT

Provider Business Mailing Address
First Line	:	5001 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021
Country	:	US
Telephone Number	:	954-234-2463
Fax Number	:	855-768-4701

Provider Business Practice Location Address
First Line	:	5001 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021
Country	:	US
Telephone Number	:	954-548-4331
Fax Number	:	888-415-6464

Authorized Official
Title or Position	:	COLLECTIONS MANAGER
Name	:	RAYMOND S TUCKER
Credential	:
Telephone Number	:	945-234-2463

Provider Enumeration Date	:	11/12/2014
Last Update Date	:	11/22/2016

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Directions to “RECOVERY IN THE LIGHT ” Practice Location

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