Basic Information
| Provider Information | |||||||||
| NPI: | 1730374539 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PALM BEACH RECOVERY COALITION, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3923 LAKE WORTH RD | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | LAKE WORTH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334614049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545877771 | ||||||||
| FaxNumber: | 9545878622 | ||||||||
| Practice Location | |||||||||
| Address1: | 3923 LAKE WORTH RD | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | LAKE WORTH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334614049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545877771 | ||||||||
| FaxNumber: | 9545878622 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2007 | ||||||||
| LastUpdateDate: | 09/14/2007 | ||||||||
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| AuthorizedOfficialLastName: | SKOLNICK | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5613865307 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283X00000X | 1550AD813001 | FL | Y | Hospitals | Rehabilitation Hospital |
No ID Information.