Provider Demographics
NPI:1457658536
Name:WELLINGTON RETREAT, INC.
Entity Type:Organization
Organization Name:WELLINGTON RETREAT, INC.
Other - Org Name:FAMILY CENTER FOR RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/BILLING/CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:JAYNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BAZZANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-732-8299
Mailing Address - Street 1:7051 SEACREST BLVD
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-5139
Mailing Address - Country:US
Mailing Address - Phone:561-296-5288
Mailing Address - Fax:561-623-0089
Practice Address - Street 1:7051 SEACREST BLVD
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-5139
Practice Address - Country:US
Practice Address - Phone:561-296-5288
Practice Address - Fax:561-623-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
323P00000X
FL1550AD780401324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility