MEDICARE: PRISMA RECOVERY 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	323P00000X	Psychiatric Residential Treatment Facility

General Provider Information

NPI Number	:	1770327207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRISMA RECOVERY CENTER LLC

Provider Business Mailing Address
First Line	:	120 N FEDERAL HWY STE 206
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-3493
Country	:	US
Telephone Number	:	772-812-9652
Fax Number	:	833-535-0164

Provider Business Practice Location Address
First Line	:	7205 CYPRESS DR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-2975
Country	:	US
Telephone Number	:	772-812-9652
Fax Number	:	833-535-0164

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	JARED TURNER
Credential	:
Telephone Number	:	772-812-9652

Provider Enumeration Date	:	06/20/2024
Last Update Date	:	06/20/2024

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