MEDICARE: THE EDGE RECOVERY, 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	251S00000X	Community/Behavioral Health Agency		FL
2	324500000X	Substance Abuse Rehabilitation Facility		FL

General Provider Information

NPI Number	:	1548706898
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE EDGE RECOVERY, LLC

Provider Business Mailing Address
First Line	:	3000 NW 101ST LN
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-3930
Country	:	US
Telephone Number	:	844-435-7804
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 NW 101ST LN
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-3930
Country	:	US
Telephone Number	:	844-435-7804
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	HERBERITO MARTINEZ
Credential	:
Telephone Number	:	844-435-7804

Provider Enumeration Date	:	01/10/2017
Last Update Date	:	01/30/2017

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