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Organization

FALLING LEAVES RECOVERY LLC

Active
Other names
Fallen Leaves Recovery LLC
Organization subpart
No

Provider details

NPI number
Authorized official
MARK SHEPPARD (CFO)
(832) 289-3350
Entity
Organization

Contact information

Practice address
15485 EAGLE NEST LN, SUITE 210 & 230, MIAMI LAKES, FL 33014-2247
(786) 332-2218
(786) 332-4994
Mailing address
5079 N DIXIE HWY, 198, OAKLAND PARK, FL 33334-4000
(786) 332-2218
(954) 357-3624

Taxonomy

Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
1302
FL
324500000X
Substance Abuse Rehabilitation Facility
Primary
1302
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
10D2122335
CLIA
FL
01
YGC
BCBS
FL
01
Z4YG9
BCBS GROUP ID
FL
Enumeration date
05/26/2016
Last updated
07/21/2022
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