Provider Demographics
NPI:1700249604
Name:PRIDE RECOVERY CENTER LLC
Entity Type:Organization
Organization Name:PRIDE RECOVERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:MERKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-783-7100
Mailing Address - Street 1:1101 E SAMPLE ROAD
Mailing Address - Street 2:
Mailing Address - City:POMPANO
Mailing Address - State:FL
Mailing Address - Zip Code:33064
Mailing Address - Country:US
Mailing Address - Phone:561-704-6781
Mailing Address - Fax:561-562-8193
Practice Address - Street 1:2206 W ATLANTIC AVE. SUITE 203
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445
Practice Address - Country:US
Practice Address - Phone:561-289-8073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder