Provider Demographics
NPI:1437507894
Name:RECOVERY IN THE LIGHT LLC
Entity Type:Organization
Organization Name:RECOVERY IN THE LIGHT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PICILLO
Authorized Official - Suffix:
Authorized Official - Credentials:OFFICE MGR
Authorized Official - Phone:954-234-2469
Mailing Address - Street 1:5001 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6515
Mailing Address - Country:US
Mailing Address - Phone:954-234-2469
Mailing Address - Fax:954-204-0464
Practice Address - Street 1:5001 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6515
Practice Address - Country:US
Practice Address - Phone:954-234-2469
Practice Address - Fax:954-204-0464
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RECOVERY IN THE LIGHT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-26
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME558192084P0800X
FL261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Single Specialty