# IMMERSION RECOVERY CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295198208
- **Authorized official:** JUSTIN WILLIAM (ADMINISTRATOR)
- **Authorized official phone:** (561) 863-5904

## Contact information

- **Practice address:** 1700 W WOOLBRIGHT RD STE 4, BOYNTON BEACH, FL 33426-6346
- **Practice address phone:** (561) 843-5904
- **Mailing address:** 1700 W WOOLBRIGHT RD STE 4, BOYNTON BEACH, FL 33426-6346

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TA0400X | Addiction (Substance Use Disorder) Psychologist | — | NULL | Yes |
| 103TA0400X | Addiction (Substance Use Disorder) Psychologist | — | — | Yes |

## Other

- **Enumeration date:** 03/29/2016
- **Last updated:** 03/29/2016