Provider Demographics
NPI:1093587685
Name:PRISMA RECOVERY CENTER LLC
Entity Type:Organization
Organization Name:PRISMA RECOVERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-812-9652
Mailing Address - Street 1:120 N FEDERAL HWY STE 206
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-3493
Mailing Address - Country:US
Mailing Address - Phone:772-812-9652
Mailing Address - Fax:833-535-0164
Practice Address - Street 1:7205 CYPRESS DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2975
Practice Address - Country:US
Practice Address - Phone:772-812-9652
Practice Address - Fax:833-535-0164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-26
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility