Provider Demographics
NPI:1093103251
Name:SOUND RECOVERY SOLUTIONS LLC
Entity Type:Organization
Organization Name:SOUND RECOVERY SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:JARVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:857-225-1998
Mailing Address - Street 1:2512 N FEDERAL HWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-6147
Mailing Address - Country:US
Mailing Address - Phone:857-225-1998
Mailing Address - Fax:
Practice Address - Street 1:2512 N FEDERAL HWY
Practice Address - Street 2:SUITE 105
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-6147
Practice Address - Country:US
Practice Address - Phone:857-225-1998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-22
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5047165841301207QA0401X, 261QR0405X
261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty