Provider Demographics
NPI:1881014405
Name:RECOVERY INSTITUTE OF THE SOUTH EAST P.A.
Entity Type:Organization
Organization Name:RECOVERY INSTITUTE OF THE SOUTH EAST P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, OWNER, ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BET
Authorized Official - Middle Name:
Authorized Official - Last Name:SHADDINGER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:800-723-9788
Mailing Address - Street 1:915 MIDDLE RIVER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3559
Mailing Address - Country:US
Mailing Address - Phone:800-723-9788
Mailing Address - Fax:800-723-9788
Practice Address - Street 1:915 MIDDLE RIVER DR STE 201
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3559
Practice Address - Country:US
Practice Address - Phone:800-723-9788
Practice Address - Fax:800-723-9788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-22
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL382147100Medicaid
FL017837600Medicaid