Provider Demographics
NPI:1164907366
Name:THE TREATMENT CENTER BY THE RECOVERY VILLAGE, LLC
Entity Type:Organization
Organization Name:THE TREATMENT CENTER BY THE RECOVERY VILLAGE, LLC
Other - Org Name:THE RECOVERY VILLAGE PALM BEACH AT BAPTIST HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSING & CONTRACTING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SURUJON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-300-3120
Mailing Address - Street 1:100 SE 3RD AVENUE
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:FT. LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33394
Mailing Address - Country:US
Mailing Address - Phone:754-300-3120
Mailing Address - Fax:888-919-4431
Practice Address - Street 1:4905 LANTANA RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-6915
Practice Address - Country:US
Practice Address - Phone:754-300-3120
Practice Address - Fax:888-919-4431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-03
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility