Provider Demographics
NPI:1669039061
Name:PREMIERE ADDICTION RECOVERY, LLC
Entity Type:Organization
Organization Name:PREMIERE ADDICTION RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAUD
Authorized Official - Suffix:
Authorized Official - Credentials:MNM, CAP, CRRA
Authorized Official - Phone:561-722-8055
Mailing Address - Street 1:5713 CORPORATE WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2045
Mailing Address - Country:US
Mailing Address - Phone:561-722-8055
Mailing Address - Fax:
Practice Address - Street 1:225 N BURNETT RD
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32926-4242
Practice Address - Country:US
Practice Address - Phone:561-722-8055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit