Immersion Recovery Center LLC

Primary specialty

Addiction (Substance Use Disorder) PsychologistTaxonomy code 103TA0400X

Legal business name

IMMERSION RECOVERY CENTER LLC

Practice address

1700 W Woolbright Rd Ste 4
Boynton Beach, FL 33426-6346

Phone

(561) 843-5904

NPI assigned

Mar 29, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Justin William

Title

Administrator

Phone

(561) 863-5904

Specialties & licenses 1

Addresses

Tax ID family

Guardian Recovery Immersion Outpatient LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Guardian Recovery Immersion Outpatient, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Delray Beach, FL
  • NPI 1568821056
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1459209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459209600000",
    "number": "1295198208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 W WOOLBRIGHT RD STE 4",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334266346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 W WOOLBRIGHT RD STE 4",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334266346",
            "telephone_number": "561-843-5904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMMERSION RECOVERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-29",
        "last_updated": "2016-03-29",
        "status": "A",
        "authorized_official_last_name": "WILLIAM",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "561-863-5904"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Addiction (Substance Use Disorder) Psychologist in Boynton Beach, FL
• Providers in Boynton Beach, FL by specialty
• Addiction (Substance Use Disorder) Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.