Provider Demographics
NPI:1285088617
Name:A ROAD TO RECOVERY DETOX, LLC
Entity type:Organization
Organization Name:A ROAD TO RECOVERY DETOX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:FERRARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-971-6021
Mailing Address - Street 1:6971 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-8229
Mailing Address - Country:US
Mailing Address - Phone:772-466-7111
Mailing Address - Fax:772-466-9991
Practice Address - Street 1:2749 SW PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2806
Practice Address - Country:US
Practice Address - Phone:772-466-7111
Practice Address - Fax:772-466-9991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility