Provider Demographics
NPI:1679023766
Name:INTERNATIONAL RECOVERY CENTER
Entity Type:Organization
Organization Name:INTERNATIONAL RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:FUNDORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-600-3255
Mailing Address - Street 1:1825 NW 112TH AVE
Mailing Address - Street 2:SUITE 151
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-1815
Mailing Address - Country:US
Mailing Address - Phone:305-600-3255
Mailing Address - Fax:844-330-8261
Practice Address - Street 1:1825 NW 112TH AVE
Practice Address - Street 2:SUITE 151
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-1815
Practice Address - Country:US
Practice Address - Phone:305-600-3255
Practice Address - Fax:844-330-8261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility