MEDICARE: UNITED RECOVERY CENTERS 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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1669926002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED RECOVERY CENTERS LLC

Provider Business Mailing Address
First Line	:	340 16TH AVE N
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-4819
Country	:	US
Telephone Number	:	305-467-8666
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 16TH AVE N
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-4819
Country	:	US
Telephone Number	:	305-467-8666
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	RICK LUCAS
Credential	:
Telephone Number	:	305-467-8666

Provider Enumeration Date	:	08/13/2016
Last Update Date	:	08/13/2016

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