Provider Demographics
NPI:1790002558
Name:ADVANCE RECOVERY CENTER, INC
Entity Type:Organization
Organization Name:ADVANCE RECOVERY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:FRYDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-274-7417
Mailing Address - Street 1:1300 NW 17TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-2560
Mailing Address - Country:US
Mailing Address - Phone:561-274-7417
Mailing Address - Fax:561-274-8715
Practice Address - Street 1:1300 NW 17TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-2560
Practice Address - Country:US
Practice Address - Phone:561-274-7417
Practice Address - Fax:561-274-8715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1550AD463901324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility