Provider Demographics
NPI:1497153563
Name:RECO INTENSIVE OP LLC
Entity Type:Organization
Organization Name:RECO INTENSIVE OP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PASQUALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-808-7986
Mailing Address - Street 1:140 NE 4TH AVE
Mailing Address - Street 2:SUITE D,B,C
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-4570
Mailing Address - Country:US
Mailing Address - Phone:561-808-7986
Mailing Address - Fax:
Practice Address - Street 1:140 NE 4TH AVE
Practice Address - Street 2:SUITE D, B, C
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-4570
Practice Address - Country:US
Practice Address - Phone:561-808-7986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-05
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL291U00000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No291U00000XLaboratoriesClinical Medical Laboratory