Provider Demographics
NPI:1659759116
Name:SIMPLE PATH RECOVERY
Entity Type:Organization
Organization Name:SIMPLE PATH RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANSANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-252-9389
Mailing Address - Street 1:1990 N FEDERAL HWY STE A
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-1032
Mailing Address - Country:US
Mailing Address - Phone:954-532-9201
Mailing Address - Fax:954-366-1430
Practice Address - Street 1:1990 N FEDERAL HWY STE A
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-1032
Practice Address - Country:US
Practice Address - Phone:954-532-9201
Practice Address - Fax:954-366-1430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder