Provider Demographics
NPI:1568887545
Name:NR FLORIDA ASSOCIATES LLC
Entity Type:Organization
Organization Name:NR FLORIDA ASSOCIATES LLC
Other - Org Name:RETREAT BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:KOROGODSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-542-0687
Mailing Address - Street 1:4020 LAKE WORTH RD
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-3918
Mailing Address - Country:US
Mailing Address - Phone:561-444-3512
Mailing Address - Fax:800-915-6119
Practice Address - Street 1:4020 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-3918
Practice Address - Country:US
Practice Address - Phone:561-444-3512
Practice Address - Fax:800-915-6119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-27
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 261QM0850X, 261QR0405X, 283Q00000X, 323P00000X
FL324500000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No283Q00000XHospitalsPsychiatric Hospital
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110833001Medicaid
FL110833000Medicaid
FL110606100Medicaid