MEDICARE: PALM BEACH 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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1922400928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALM BEACH RECOVERY CENTER, LLC

Provider Business Mailing Address
First Line	:	1 FINANCIAL PLAZA SUITE 1101
Second Line	:	100 SE THIRD AVENUE SUITE 1101
City	:	FT. LAUDERDALE
State	:	FL
Zip	:	33394
Country	:	US
Telephone Number	:	954-615-1700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 FINANCIAL PLAZA, 100 SE THIRD AVENUE
Second Line	:	SUITE 1101
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33394
Country	:	US
Telephone Number	:	954-615-1700
Fax Number	:

Authorized Official
Title or Position	:	CHIEF LEGAL OFFICER
Name	:	STEWART GOLD
Credential	:
Telephone Number	:	954-615-1700

Provider Enumeration Date	:	09/22/2014
Last Update Date	:	11/24/2014

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