Provider Demographics
NPI:1730614769
Name:WHITE HOUSE RECOVERY CENTERS LLC
Entity type:Organization
Organization Name:WHITE HOUSE RECOVERY CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-203-3584
Mailing Address - Street 1:1111 HYPOLUXO RD STE 207
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-4271
Mailing Address - Country:US
Mailing Address - Phone:561-530-7393
Mailing Address - Fax:954-856-2904
Practice Address - Street 1:811 SE 8TH AVE # 206209
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-5644
Practice Address - Country:US
Practice Address - Phone:561-530-7393
Practice Address - Fax:956-856-2904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0601261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder