Provider Demographics
NPI:1992129357
Name:ROAD TO RECOVERY
Entity type:Organization
Organization Name:ROAD TO RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-236-2073
Mailing Address - Street 1:2325 WELLINGTON GR DR
Mailing Address - Street 2:#106
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414
Mailing Address - Country:US
Mailing Address - Phone:561-236-2073
Mailing Address - Fax:888-602-1253
Practice Address - Street 1:2325 WELLINGTON GREEN DR
Practice Address - Street 2:#106
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-9315
Practice Address - Country:US
Practice Address - Phone:561-236-2073
Practice Address - Fax:888-602-1253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10D2070282OtherCLIA