Provider Demographics
NPI:1003527581
Name:POLK FOR RECOVERY, INC.
Entity Type:Organization
Organization Name:POLK FOR RECOVERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKOS
Authorized Official - Suffix:
Authorized Official - Credentials:CRSS
Authorized Official - Phone:863-288-6522
Mailing Address - Street 1:3031 EAGLE HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-5208
Mailing Address - Country:US
Mailing Address - Phone:863-288-6522
Mailing Address - Fax:
Practice Address - Street 1:244 AVENUE D SW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3423
Practice Address - Country:US
Practice Address - Phone:863-288-6522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health