1730628652 NPI number — ALLY RECOVERY GROUP

Table of content: (NPI 1730628652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730628652 NPI number — ALLY RECOVERY GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLY RECOVERY GROUP
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:
Provider Other Organization Name Type Code:
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:
1730628652
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 S STATE ROAD 7
Provider Second Line Business Mailing Address:
SUITE 122
Provider Business Mailing Address City Name:
ROYAL PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33414-4303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-469-8336
Provider Business Mailing Address Fax Number:
561-619-9367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 S STATE ROAD 7
Provider Second Line Business Practice Location Address:
SUITE 122
Provider Business Practice Location Address City Name:
ROYAL PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33414-4303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-469-8336
Provider Business Practice Location Address Fax Number:
561-619-9367
Provider Enumeration Date:
02/13/2017

Additional Information

Authorized Official

Authorized Official Last Name:
NEAL
Authorized Official First Name:
JUDIE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF ADMINISTRATIVE SERVICES
Authorized Official Telephone Number:
561-469-8336

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RA0401X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1053860262 . This is a "OUT PATIENT FACILITY" identifier . This identifiers is of the category "OTHER".




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