Provider Demographics
NPI:1679052500
Name:RECOVERY TEAM BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:RECOVERY TEAM BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIRILL
Authorized Official - Middle Name:
Authorized Official - Last Name:VESSELOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-818-9901
Mailing Address - Street 1:509 N FEDERAL HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33403-3573
Mailing Address - Country:US
Mailing Address - Phone:561-882-9821
Mailing Address - Fax:
Practice Address - Street 1:509 FEDERAL HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33403-3573
Practice Address - Country:US
Practice Address - Phone:561-882-9821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-10
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty