Provider Demographics
NPI:1346698693
Name:FALLING LEAVES RECOVERY LLC
Entity Type:Organization
Organization Name:FALLING LEAVES RECOVERY LLC
Other - Org Name:FALLEN LEAVES RECOVERY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPPARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-289-3350
Mailing Address - Street 1:5079 N DIXIE HWY
Mailing Address - Street 2:198
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-4000
Mailing Address - Country:US
Mailing Address - Phone:786-332-2218
Mailing Address - Fax:954-357-3624
Practice Address - Street 1:15485 EAGLE NEST LN
Practice Address - Street 2:SUITE 210 & 230
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2247
Practice Address - Country:US
Practice Address - Phone:786-332-2218
Practice Address - Fax:786-332-4994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1302261QR0405X, 324500000X
FL13=========02324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10D2122335OtherCLIA
FLYGCOtherBCBS
FLZ4YG9OtherBCBS GROUP ID
FL10D2122335OtherCLIA