Provider Demographics
NPI:1568828978
Name:COCONUT GROVE RECOVERY LLC
Entity Type:Organization
Organization Name:COCONUT GROVE RECOVERY LLC
Other - Org Name:MORE LIFE RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BOTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-212-8122
Mailing Address - Street 1:5001 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021
Mailing Address - Country:US
Mailing Address - Phone:866-212-8122
Mailing Address - Fax:855-295-2937
Practice Address - Street 1:5001 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:866-212-8122
Practice Address - Fax:855-295-2937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder