Provider Demographics
NPI:1912384702
Name:SAFE HARBOUR RECOVERY LLC
Entity Type:Organization
Organization Name:SAFE HARBOUR RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTORANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-444-1835
Mailing Address - Street 1:5601 CORPORATE WAY STE 320
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2043
Mailing Address - Country:US
Mailing Address - Phone:954-444-1835
Mailing Address - Fax:
Practice Address - Street 1:5601 CORPORATE WAY STE 320
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2043
Practice Address - Country:US
Practice Address - Phone:954-444-1835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility