Provider Demographics
NPI:1568821056
Name:IMMERSION RECOVERY CENTER LLC
Entity Type:Organization
Organization Name:IMMERSION RECOVERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICAL
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSALIND
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-607-8075
Mailing Address - Street 1:3333 S CONGRESS AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-7308
Mailing Address - Country:US
Mailing Address - Phone:561-877-8232
Mailing Address - Fax:
Practice Address - Street 1:3333 S CONGRESS AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-7308
Practice Address - Country:US
Practice Address - Phone:561-843-5904
Practice Address - Fax:561-877-8041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-12
Last Update Date:2023-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder