1861758732 NPI number — RECOVERY HOME CARE, INC.

Table of content: (NPI 1861758732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861758732 NPI number — RECOVERY HOME CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RECOVERY HOME CARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861758732
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
544 NW UNIVERSITY BLVD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
PORT ST LUCIE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34986-2283
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-200-2760
Provider Business Mailing Address Fax Number:
772-200-2760

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 E COMMERCIAL BLVD
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
OAKLAND PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33334-3391
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-351-8814
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/05/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SKULA
Authorized Official First Name:
GINNAH
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF BILLING
Authorized Official Telephone Number:
772-200-2760

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  299991378 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 107679 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".




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