MEDICARE: RECOVERY IN THE LIGHT

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	291U00000X	Clinical Medical Laboratory		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10D2085719	OTHER	FL	CLIA LICENSE
2	800027831	OTHER	FL	CLINICAL LABORATORY

General Provider Information

NPI Number	:	1922557446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECOVERY IN THE LIGHT

Provider Business Mailing Address
First Line	:	5001 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6515
Country	:	US
Telephone Number	:	855-366-5224
Fax Number	:	855-768-4701

Provider Business Practice Location Address
First Line	:	5001 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6515
Country	:	US
Telephone Number	:	855-366-5224
Fax Number	:	855-768-4701

Authorized Official
Title or Position	:	BILLING COLLECTION MANAGER
Name	:	CATHY PICILLO
Credential	:
Telephone Number	:	954-993-7165

Provider Enumeration Date	:	09/26/2016
Last Update Date	:	04/28/2017

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Directions to “RECOVERY IN THE LIGHT ” Practice Location

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