MEDICARE: DELRAY RECOVERY CENTER

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

General Provider Information

NPI Number	:	1639532138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELRAY RECOVERY CENTER

Provider Business Mailing Address
First Line	:	5410 EAST AVE
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-2344
Country	:	US
Telephone Number	:	561-404-5976
Fax Number	:	561-430-5712

Provider Business Practice Location Address
First Line	:	5408 EAST AVE
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-2344
Country	:	US
Telephone Number	:	561-404-5979
Fax Number	:	561-430-5712

Authorized Official
Title or Position	:	CFO
Name	:	PETER WALSTROM
Credential	:	CFO
Telephone Number	:	561-404-5976

Provider Enumeration Date	:	04/01/2016
Last Update Date	:	04/01/2016

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Directions to “DELRAY RECOVERY CENTER ” Practice Location

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