Provider Demographics
NPI:1992378558
Name:IRECOVERY, LLC
Entity Type:Organization
Organization Name:IRECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:
Authorized Official - Last Name:CINTRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-235-7683
Mailing Address - Street 1:5030 CHAMPION BLVD STE G11-535
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-2473
Mailing Address - Country:US
Mailing Address - Phone:561-235-7683
Mailing Address - Fax:561-464-5501
Practice Address - Street 1:14 E WASHINGTON ST STE 200-A20
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-2354
Practice Address - Country:US
Practice Address - Phone:407-743-7797
Practice Address - Fax:561-464-5501
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IRECOVERY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-21
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107100603Medicaid