Provider Demographics
NPI:1386197903
Name:LIFE RECOVERY OF THE PALM BEACHES
Entity Type:Organization
Organization Name:LIFE RECOVERY OF THE PALM BEACHES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLIENT ONBOARDING SUPERVISOR
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 1:919 N DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3329
Mailing Address - Country:US
Mailing Address - Phone:561-290-0540
Mailing Address - Fax:
Practice Address - Street 1:919 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3329
Practice Address - Country:US
Practice Address - Phone:561-290-0540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care