Provider Demographics
NPI:1144586025
Name:FAMILY ADDICTION RECOVERY, LLC
Entity Type:Organization
Organization Name:FAMILY ADDICTION RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUSTAFA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-305-7220
Mailing Address - Street 1:380 SW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-7235
Mailing Address - Country:US
Mailing Address - Phone:561-305-7220
Mailing Address - Fax:561-431-5844
Practice Address - Street 1:499 E PALMETTO PARK RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-5080
Practice Address - Country:US
Practice Address - Phone:561-305-7220
Practice Address - Fax:561-431-5844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW104581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty