Organization
SQUARE ONE RECOVERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELI KORNMILLER (ONBOARDING SUPERVISOR)
(561) 672-8345
Entity
Organization
Contact information
Practice address
11576 PIERSON RD, WELLINGTON, FL 33414-8767
(561) 512-9273
(561) 345-6561
Mailing address
11576 PIERSON RD, WELLINGTON, FL 33414-8767
(561) 512-9273
(561) 345-6561
Taxonomy
Speciality
Code
Description
License number
State
261QR0800X
Recovery Care Clinic/Center
Primary
5081347114901
FL
Other
Enumeration date
10/03/2016
Last updated
01/13/2017
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