1053389452 NPI number — ARCHSTONE RECOVERY CENTER

Table of content: (NPI 1053389452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053389452 NPI number — ARCHSTONE RECOVERY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARCHSTONE RECOVERY CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RENAISSANCE RECOVERY CENTER INC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053389452
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3288
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE WORTH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33465-3288
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-588-8323
Provider Business Mailing Address Fax Number:
561-275-7998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 W PERRY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANTANA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33462-4547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-588-8323
Provider Business Practice Location Address Fax Number:
561-275-7998
Provider Enumeration Date:
03/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OFFIDANI
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
561-588-8323

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MH9732 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: ME55561 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: OS8387 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X , with the licence number: 0950ADA666 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , with the licence number: 10D2039250 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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