Provider Demographics
NPI:1457130346
Name:NAMASTE RECOVERY CENTER LLC
Entity Type:Organization
Organization Name:NAMASTE RECOVERY CENTER LLC
Other - Org Name:LIVE OAK DETOX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CODY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEELEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-225-3343
Mailing Address - Street 1:912 AVENUE I
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-2237
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:912 AVENUE I
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-2237
Practice Address - Country:US
Practice Address - Phone:561-531-0334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-28
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility