NPIMap

Organization Active NPI

Square One Recovery, LLC

  • Recovery Care Clinic/Center
  • Wellington, FL
National Provider Identifier
1578012589
Registry record updated Jan 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Recovery Care Clinic/CenterTaxonomy code 261QR0800X
License
5081347114901 Issued in FL
Legal business name
SQUARE ONE RECOVERY, LLC
Practice address
11576 Pierson Rd
Wellington, FL 33414-8767
Phone
(561) 512-9273
Fax
(561) 345-6561
NPI assigned
Oct 3, 2016
Last updated
Jan 13, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2017

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

Authorized official

Name
Keli Kornmiller
Title
Onboarding Supervisor
Phone
(561) 672-8345

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Recovery Care Clinic/Center 261QR0800X 5081347114901 FL Primary

Addresses

Primary practice location

11576 Pierson Rd
Wellington, FL 33414-8767

Mailing address

11576 Pierson Rd
Wellington, FL 33414-8767
Phone (561) 512-9273

National Provider Directory

National Provider Directory
Tax ID family
Square One Recovery 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.

NPI Registry JSON

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

{
    "created_epoch": "1475452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484265600000",
    "number": "1578012589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11576 PIERSON RD",
            "city": "WELLINGTON",
            "state": "FL",
            "postal_code": "334148767",
            "telephone_number": "561-512-9273",
            "fax_number": "561-345-6561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11576 PIERSON RD",
            "city": "WELLINGTON",
            "state": "FL",
            "postal_code": "334148767",
            "telephone_number": "561-512-9273",
            "fax_number": "561-345-6561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SQUARE ONE RECOVERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-03",
        "last_updated": "2017-01-13",
        "status": "A",
        "authorized_official_last_name": "KORNMILLER",
        "authorized_official_first_name": "KELI",
        "authorized_official_title_or_position": "ONBOARDING SUPERVISOR",
        "authorized_official_telephone_number": "561-672-8345"
    },
    "taxonomies": [
        {
            "code": "261QR0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Recovery Care",
            "state": "FL",
            "license": "5081347114901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wellington, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2017; 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.