Provider Demographics
NPI:1225494529
Name:ROCKIN RECOVERY LIFE SKILLS, LLC
Entity Type:Organization
Organization Name:ROCKIN RECOVERY LIFE SKILLS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KELI
Authorized Official - Middle Name:
Authorized Official - Last Name:KORNMILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-672-8345
Mailing Address - Street 1:PO BOX 6542
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33482-6542
Mailing Address - Country:US
Mailing Address - Phone:561-255-3573
Mailing Address - Fax:561-808-7394
Practice Address - Street 1:265 NE 5TH AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-5530
Practice Address - Country:US
Practice Address - Phone:561-255-3573
Practice Address - Fax:561-808-7394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0800X
FL1550AD185301324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility