MEDICARE: SIMPLE PATH RECOVERY

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1659759116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMPLE PATH RECOVERY

Provider Business Mailing Address
First Line	:	1990 N FEDERAL HWY STE A
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-1032
Country	:	US
Telephone Number	:	954-532-9201
Fax Number	:	954-366-1430

Provider Business Practice Location Address
First Line	:	1990 N FEDERAL HWY STE A
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-1032
Country	:	US
Telephone Number	:	954-532-9201
Fax Number	:	954-366-1430

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SAMANTHA VANSANT
Credential	:
Telephone Number	:	561-252-9389

Provider Enumeration Date	:	05/15/2015
Last Update Date	:	05/15/2015

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Directions to “SIMPLE PATH RECOVERY ” Practice Location

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