MEDICARE: POSITIVE PATH OF DEERFIELD BEACH

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1730561358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POSITIVE PATH OF DEERFIELD BEACH

Provider Business Mailing Address
First Line	:	1400 EAST HILLSBORO BLVD
Second Line	:	2ND FLOOR
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 EAST HILLSBORO BLVD
Second Line	:	2ND FLOOR
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441
Country	:	US
Telephone Number	:	561-715-3260
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	JORDAN NEEDELL
Credential	:
Telephone Number	:	561-715-3260

Provider Enumeration Date	:	06/19/2015
Last Update Date	:	06/19/2015

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