MEDICARE: STAY STOPPED RECOVERY SUPPORT SERVICIES 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	251S00000X	Community/Behavioral Health Agency
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1770974560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAY STOPPED RECOVERY SUPPORT SERVICIES INC

Provider Business Mailing Address
First Line	:	2860 NW 187TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-3131
Country	:	US
Telephone Number	:	786-991-6067
Fax Number	:

Provider Business Practice Location Address
First Line	:	2860 NW 187TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-3131
Country	:	US
Telephone Number	:	786-991-6067
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CURTIS A JACKSON
Credential	:
Telephone Number	:	786-991-6067

Provider Enumeration Date	:	02/15/2015
Last Update Date	:	02/15/2015

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