Provider Demographics
NPI:1689143794
Name:THE GIFT OF RECOVERY, LLC
Entity Type:Organization
Organization Name:THE GIFT OF RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDAGE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:404-809-7764
Mailing Address - Street 1:1225 E RIVER DR
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-3635
Mailing Address - Country:US
Mailing Address - Phone:954-805-0177
Mailing Address - Fax:888-293-5884
Practice Address - Street 1:1801 SW HILLMOOR DRIVE
Practice Address - Street 2:SUITE C-101
Practice Address - City:PORT ST. LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952
Practice Address - Country:US
Practice Address - Phone:954-805-0177
Practice Address - Fax:888-293-5884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH11708OtherPRIVATE PRACTITIONER