MEDICARE: SANDS TREATMENT CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1477166494
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDS TREATMENT CENTER LLC

Provider Business Mailing Address
First Line	:	2100 PARK CENTRAL BLVD N STE 900
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33064-2242
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 PARK CENTRAL BLVD N STE 900
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33064-2242
Country	:	US
Telephone Number	:	860-574-2710
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	ROBERT SALMONS
Credential	:
Telephone Number	:	609-509-9533

Provider Enumeration Date	:	08/28/2020
Last Update Date	:	10/08/2021

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