Provider Demographics
NPI:1295155059
Name:OCEAN RECOVERY
Entity type:Organization
Organization Name:OCEAN RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-929-6900
Mailing Address - Street 1:115 W WOOLBRIGHT RD STE A
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-5908
Mailing Address - Country:US
Mailing Address - Phone:561-929-6900
Mailing Address - Fax:888-510-9071
Practice Address - Street 1:115 W WOOLBRIGHT RD STE A
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-5908
Practice Address - Country:US
Practice Address - Phone:561-929-6900
Practice Address - Fax:888-510-9071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10D2074910320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10D2074910OtherCLIA