MEDICARE: EMERGE RECOVERY WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QM0850X	Adult Mental Health Clinic/Center
3	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
4	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1740720234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERGE RECOVERY WELLNESS

Provider Business Mailing Address
First Line	:	1280 N CONGRESS AVE
Second Line	:	SUITE 108
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6377
Country	:	US
Telephone Number	:	561-228-1598
Fax Number	:

Provider Business Practice Location Address
First Line	:	1280 N CONGRESS AVE
Second Line	:	SUITE 108
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6377
Country	:	US
Telephone Number	:	561-228-1598
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	GWEN PHILLIPS
Credential	:	M.A., MCAP
Telephone Number	:	561-228-1598

Provider Enumeration Date	:	03/02/2017
Last Update Date	:	03/07/2017

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Directions to “EMERGE RECOVERY WELLNESS ” Practice Location

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