Provider Demographics
NPI:1619356912
Name:GREENWAY RECOVERY LLC
Entity type:Organization
Organization Name:GREENWAY RECOVERY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:DUGGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, LMFT ,NCC, ACS
Authorized Official - Phone:561-413-9860
Mailing Address - Street 1:230 E OCEAN AVE
Mailing Address - Street 2:228 EAST OCEAN AVENUE
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-3236
Mailing Address - Country:US
Mailing Address - Phone:561-577-1990
Mailing Address - Fax:
Practice Address - Street 1:230 E OCEAN AVE
Practice Address - Street 2:228 EAST OCEAN AVE
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-3236
Practice Address - Country:US
Practice Address - Phone:561-469-6472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1550AD019301261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder