Provider Demographics
NPI:1205578101
Name:ADVANCED RECOVERY & COUNSELING LLC
Entity type:Organization
Organization Name:ADVANCED RECOVERY & COUNSELING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEAD OF BUSINESS
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:BERNARDO
Authorized Official - Last Name:BOTERO
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:786-916-6073
Mailing Address - Street 1:14400 NW 77TH CT STE 100
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1590
Mailing Address - Country:US
Mailing Address - Phone:786-916-6073
Mailing Address - Fax:786-657-3092
Practice Address - Street 1:7241 SW 63RD AVE STE 101A
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4838
Practice Address - Country:US
Practice Address - Phone:786-916-6073
Practice Address - Fax:786-657-3092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-11
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107662100Medicaid
FL104616600Medicaid