Provider Demographics
NPI:1396340683
Name:US RECOVERY CENTERS, LLC
Entity type:Organization
Organization Name:US RECOVERY CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-573-4961
Mailing Address - Street 1:501 S BLAIR STONE RD APT 302
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-3026
Mailing Address - Country:US
Mailing Address - Phone:561-573-4961
Mailing Address - Fax:
Practice Address - Street 1:401 E BYRD AVE
Practice Address - Street 2:
Practice Address - City:BONIFAY
Practice Address - State:FL
Practice Address - Zip Code:32425-3007
Practice Address - Country:US
Practice Address - Phone:561-573-4961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility