Provider Demographics
NPI:1487101622
Name:SQUARE ONE RECOVERY LLC
Entity type:Organization
Organization Name:SQUARE ONE RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRISINA
Authorized Official - Suffix:
Authorized Official - Credentials:BS,CAC
Authorized Official - Phone:561-512-9273
Mailing Address - Street 1:11576 PIERSON RD
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8767
Mailing Address - Country:US
Mailing Address - Phone:561-512-9273
Mailing Address - Fax:
Practice Address - Street 1:11576 PIERSON RD
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8767
Practice Address - Country:US
Practice Address - Phone:561-512-9273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1184849093OtherSUBSTANCE ABUSE TREATMENT CENTER