Provider Demographics
NPI:1598386807
Name:RIVERWALK RECOVERY CENTER, LLC
Entity Type:Organization
Organization Name:RIVERWALK RECOVERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FARACHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-264-2600
Mailing Address - Street 1:1645 PALM BEACH LAKES BLVD STE 1010
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2218
Mailing Address - Country:US
Mailing Address - Phone:423-264-2600
Mailing Address - Fax:
Practice Address - Street 1:7446 SHALLOWFORD RD STE 116
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2352
Practice Address - Country:US
Practice Address - Phone:423-264-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-28
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility