Provider Demographics
NPI:1881907061
Name:HALLWAY OF LIFE RECOVERY CENTER INC.
Entity type:Organization
Organization Name:HALLWAY OF LIFE RECOVERY CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LACRESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-908-6277
Mailing Address - Street 1:23257 STATE ROAD 7
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-5448
Mailing Address - Country:US
Mailing Address - Phone:561-908-6277
Mailing Address - Fax:561-908-6277
Practice Address - Street 1:137 S SWINTON AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-3669
Practice Address - Country:US
Practice Address - Phone:561-908-6277
Practice Address - Fax:561-908-6277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10D2003348291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory