Provider Demographics
NPI:1174091003
Name:INCEPTIONS RECOVERY & TREATMENT CENTER, LLC
Entity type:Organization
Organization Name:INCEPTIONS RECOVERY & TREATMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JULIAN FRANK
Authorized Official - Middle Name:F
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:EDS, MED
Authorized Official - Phone:954-257-3480
Mailing Address - Street 1:1303 N STATE ROAD 7 STE B1
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-2852
Mailing Address - Country:US
Mailing Address - Phone:954-257-3480
Mailing Address - Fax:
Practice Address - Street 1:1303 N STATE ROAD 7 STE B1
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-2852
Practice Address - Country:US
Practice Address - Phone:954-257-3480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-08
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL18000258772OtherSTATE OF FLORIDA CORPORATIONS