MEDICARE: THE NEXTEP FOUNDATION, INC.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	261QR0405X	OTHER	FL	TAXONOMY

General Provider Information

NPI Number	:	1588073811
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE NEXTEP FOUNDATION, INC.

Provider Business Mailing Address
First Line	:	6559 PLANTATION PRESERVE CIR N
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-8366
Country	:	US
Telephone Number	:	239-634-9896
Fax Number	:	239-362-0710

Provider Business Practice Location Address
First Line	:	6559 PLANTATION PRESERVE CIR N
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-8366
Country	:	US
Telephone Number	:	239-634-9896
Fax Number	:	239-362-0710

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERT RAAB
Credential	:
Telephone Number	:	239-634-9896

Provider Enumeration Date	:	08/12/2014
Last Update Date	:	08/12/2014

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Directions to “THE NEXTEP FOUNDATION, INC. ” Practice Location

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