MEDICARE: RECO INSTITUTE

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
2	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1568801223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECO INSTITUTE

Provider Business Mailing Address
First Line	:	1605 RENAISSANCE COMMONS BLVD APT 537
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-8289
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1605 RENAISSANCE COMMONS BLVD APT 537
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-8289
Country	:	US
Telephone Number	:	561-665-1865
Fax Number	:

Authorized Official
Title or Position	:	BILLING DIRECTOR
Name	:	ANGELA IACULLO
Credential	:
Telephone Number	:	561-715-9288

Provider Enumeration Date	:	06/17/2013
Last Update Date	:	06/17/2013

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