MEDICARE: EMERGE RECOVERY ASSOCIATES 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	261QM0850X	Adult Mental Health Clinic/Center
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center		FL

General Provider Information

NPI Number	:	1932567930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERGE RECOVERY ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	1280 N CONGRESS AVE
Second Line	:	108
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6377
Country	:	US
Telephone Number	:	561-228-1598
Fax Number	:	844-715-4884

Provider Business Practice Location Address
First Line	:	1280 N CONGRESS AVE
Second Line	:	108
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6377
Country	:	US
Telephone Number	:	561-228-1598
Fax Number	:	844-715-4884

Authorized Official
Title or Position	:	CEO
Name	:	GWENDOLYN PHILLIPS
Credential	:
Telephone Number	:	561-228-1598

Provider Enumeration Date	:	02/04/2016
Last Update Date	:	03/03/2017

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