MEDICARE: IRECOVERY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	103T00000X	Psychologist
3	1041C0700X	Clinical Social Worker
4	363A00000X	Physician Assistant
5	2083A0300X	Addiction Medicine (Preventive Medicine) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538887492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRECOVERY, LLC

Provider Business Mailing Address
First Line	:	5030 CHAMPION BLVD STE G11-535
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33496-2473
Country	:	US
Telephone Number	:	561-235-7683
Fax Number	:	561-279-3351

Provider Business Practice Location Address
First Line	:	200 KNUTH RD STE 101
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-4635
Country	:	US
Telephone Number	:	561-375-2984
Fax Number	:	561-464-5501

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	MILDRED CINTRON
Credential	:
Telephone Number	:	561-235-7683

Provider Enumeration Date	:	08/17/2022
Last Update Date	:	08/17/2022

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Directions to “IRECOVERY, LLC ” Practice Location

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