MEDICARE: LEON F. STEWART-HAL S. MARCHMAN CENTER, 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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	261QCI500X	FL

General Provider Information

NPI Number	:	1740285196
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEON F. STEWART-HAL S. MARCHMAN CENTER, INC.

Provider Business Mailing Address
First Line	:	3875 TIGER BAY RD
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32124-1063
Country	:	US
Telephone Number	:	386-947-1328
Fax Number	:	386-947-1323

Provider Business Practice Location Address
First Line	:	3875 TIGER BAY RD
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32124-1063
Country	:	US
Telephone Number	:	386-947-1328
Fax Number	:	386-947-1323

Authorized Official
Title or Position	:	CEO
Name	:	MR. WILLIAM CHESTER BELL
Credential	:
Telephone Number	:	386-947-1480

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	08/22/2020

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