MEDICARE: NEW RIVER COMMUNITY MENTAL HEALTH 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
1	324500000X	Substance Abuse Rehabilitation Facility	1706AD157802	FL

General Provider Information

NPI Number	:	1487805933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW RIVER COMMUNITY MENTAL HEALTH CENTER, INC.

Provider Business Mailing Address
First Line	:	2962 SW 26 TERRACE
Second Line	:	SUITE 204
City	:	DANIA BEACH
State	:	FL
Zip	:	33312
Country	:	US
Telephone Number	:	954-530-6118
Fax Number	:	954-530-6419

Provider Business Practice Location Address
First Line	:	2962 SW 26 TERRACE
Second Line	:	SUITE 204
City	:	DANIA BEACH
State	:	FL
Zip	:	33312
Country	:	US
Telephone Number	:	954-530-6118
Fax Number	:	954-530-6419

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ELEANOR CHICKA
Credential	:
Telephone Number	:	954-530-6118

Provider Enumeration Date	:	10/02/2008
Last Update Date	:	09/08/2016

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