Provider Demographics
NPI:1205389749
Name:PHYSICIANS RECOVERY CENTER INC
Entity Type:Organization
Organization Name:PHYSICIANS RECOVERY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CROALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-300-4518
Mailing Address - Street 1:4782 W COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-2878
Mailing Address - Country:US
Mailing Address - Phone:754-300-4518
Mailing Address - Fax:954-530-4714
Practice Address - Street 1:4782 W COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-2878
Practice Address - Country:US
Practice Address - Phone:754-300-4518
Practice Address - Fax:954-530-4714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty