Provider Demographics
NPI:1922400928
Name:PALM BEACH RECOVERY CENTER, LLC
Entity Type:Organization
Organization Name:PALM BEACH RECOVERY CENTER, LLC
Other - Org Name:PALM BEACH DETOX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF LEGAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-615-1700
Mailing Address - Street 1:1 FINANCIAL PLAZA SUITE 1101
Mailing Address - Street 2:100 SE THIRD AVENUE SUITE 1101
Mailing Address - City:FT. LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33394
Mailing Address - Country:US
Mailing Address - Phone:954-615-1700
Mailing Address - Fax:
Practice Address - Street 1:1 FINANCIAL PLAZA, 100 SE THIRD AVENUE
Practice Address - Street 2:SUITE 1101
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33394
Practice Address - Country:US
Practice Address - Phone:954-615-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-22
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility