Provider Demographics
NPI:1992172340
Name:LIGHT OF THE WORLD REHABILITATION & RECOVERY SERVICES LLC
Entity type:Organization
Organization Name:LIGHT OF THE WORLD REHABILITATION & RECOVERY SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:BLAINE
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, BACC
Authorized Official - Phone:305-310-6618
Mailing Address - Street 1:2100 LAKE IDA RD STE 2
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-2442
Mailing Address - Country:US
Mailing Address - Phone:305-310-6618
Mailing Address - Fax:
Practice Address - Street 1:2100 LAKE IDA RD STE 2
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-2442
Practice Address - Country:US
Practice Address - Phone:305-310-6618
Practice Address - Fax:561-330-5268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-01
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder