MEDICARE: MEADOWS COUNSELING CENTER 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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1770240798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEADOWS COUNSELING CENTER LLC

Provider Business Mailing Address
First Line	:	1224 US HIGHWAY 1 STE C
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-3539
Country	:	US
Telephone Number	:	561-246-4866
Fax Number	:	561-363-4388

Provider Business Practice Location Address
First Line	:	1224 US HWY 1 STE B & C
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-3539
Country	:	US
Telephone Number	:	561-246-4866
Fax Number	:	561-363-4388

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MICHAEL ALAN GORDON
Credential	:
Telephone Number	:	561-827-7405

Provider Enumeration Date	:	11/24/2021
Last Update Date	:	05/16/2023

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