Provider Demographics
NPI:1851811004
Name:RECOVERY BOOT CAMP, LLC
Entity Type:Organization
Organization Name:RECOVERY BOOT CAMP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNELLENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-251-2770
Mailing Address - Street 1:85 SW 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-2511
Mailing Address - Country:US
Mailing Address - Phone:561-563-8888
Mailing Address - Fax:561-265-4561
Practice Address - Street 1:85 SW 5TH AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-2511
Practice Address - Country:US
Practice Address - Phone:561-563-8888
Practice Address - Fax:561-265-4561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5001261QR0800X
FL261QR0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18214773307OtherSUBSTANCE ABUSE
FL1710362272OtherSUBSTANCE ABUSE