MEDICARE: PALM BEACH RECOVERY COALITION, INC.

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	283X00000X	Rehabilitation Hospital	1550AD813001	FL

General Provider Information

NPI Number	:	1730374539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALM BEACH RECOVERY COALITION, INC.

Provider Business Mailing Address
First Line	:	3923 LAKE WORTH RD
Second Line	:	SUITE 111
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-4049
Country	:	US
Telephone Number	:	954-587-7771
Fax Number	:	954-587-8622

Provider Business Practice Location Address
First Line	:	3923 LAKE WORTH RD
Second Line	:	SUITE 111
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-4049
Country	:	US
Telephone Number	:	954-587-7771
Fax Number	:	954-587-8622

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. ANDREW SKOLNICK
Credential	:
Telephone Number	:	561-386-5307

Provider Enumeration Date	:	09/14/2007
Last Update Date	:	09/14/2007

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