Provider Demographics
NPI:1568203032
Name:SEACREST RECOVERY CENTER CINCINNATI, LLC
Entity type:Organization
Organization Name:SEACREST RECOVERY CENTER CINCINNATI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUZAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-415-3608
Mailing Address - Street 1:5300 ATLANTIC AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8141
Mailing Address - Country:US
Mailing Address - Phone:833-820-2922
Mailing Address - Fax:
Practice Address - Street 1:1 TRIANGLE PARK DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3423
Practice Address - Country:US
Practice Address - Phone:561-990-2620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health