Provider Demographics
NPI:1912445974
Name:REBEL RECOVERY FLORIDA INC
Entity Type:Organization
Organization Name:REBEL RECOVERY FLORIDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNZELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-201-0739
Mailing Address - Street 1:1893 PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-6727
Mailing Address - Country:US
Mailing Address - Phone:561-508-8388
Mailing Address - Fax:
Practice Address - Street 1:1893 PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-6727
Practice Address - Country:US
Practice Address - Phone:561-508-8388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No251V00000XAgenciesVoluntary or Charitable