1174022404 NPI number — HARMONY RIDGE RECOVERY CENTER, LLC

Table of content: (NPI 1174022404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174022404 NPI number — HARMONY RIDGE RECOVERY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARMONY RIDGE RECOVERY CENTER, LLC
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:
HARMONY RIDGE RECOVERY
Provider Other Organization Name Type Code:
3
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:
1174022404
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
675 WEST INDIANTOWN ROAD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
JUPITER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-427-6776
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
47 CHAMBERS CIRCLE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALKER
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-771-8372
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SABELLA
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
561-427-6776

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , with the licence number:  452 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: 452 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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