Provider Demographics
NPI:1184094567
Name:PEACE OF MIND RECOVERY LLC
Entity type:Organization
Organization Name:PEACE OF MIND RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR BLAKELY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-598-4215
Mailing Address - Street 1:7040 SEMINOLE PRATT WHITNEY RD
Mailing Address - Street 2:25-160
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-5714
Mailing Address - Country:US
Mailing Address - Phone:954-598-4215
Mailing Address - Fax:954-623-7627
Practice Address - Street 1:7040 SEMINOLE PRATT WHITNEY RD
Practice Address - Street 2:25-160
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-5714
Practice Address - Country:US
Practice Address - Phone:954-598-4215
Practice Address - Fax:954-623-7627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder