Provider Demographics
NPI:1447849153
Name:3D RECOVERY LLC
Entity type:Organization
Organization Name:3D RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRESTON
Authorized Official - Middle Name:J
Authorized Official - Last Name:QUEENAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:484-868-4948
Mailing Address - Street 1:132 W AMERICA ST APT 25
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3641
Mailing Address - Country:US
Mailing Address - Phone:484-868-4948
Mailing Address - Fax:
Practice Address - Street 1:612 E COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4650
Practice Address - Country:US
Practice Address - Phone:484-868-4948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-16
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health