Provider Demographics
NPI:1922877323
Name:RENAISSANCE RECOVERY FLORIDA LLC
Entity Type:Organization
Organization Name:RENAISSANCE RECOVERY FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:REESE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-742-0172
Mailing Address - Street 1:824 LAKE AVE STE 179
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-3754
Mailing Address - Country:US
Mailing Address - Phone:949-742-0172
Mailing Address - Fax:
Practice Address - Street 1:327 W LANTANA RD
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-1773
Practice Address - Country:US
Practice Address - Phone:949-742-0172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder