MEDICARE: PIVOT TREATMENT AND WELLNESS CENTERS

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
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1790243640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIVOT TREATMENT AND WELLNESS CENTERS

Provider Business Mailing Address
First Line	:	330 US 1 STE 3
Second Line	:
City	:	LAKE PARK
State	:	FL
Zip	:	33403-3531
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 US 1 STE 3
Second Line	:
City	:	LAKE PARK
State	:	FL
Zip	:	33403-3531
Country	:	US
Telephone Number	:	800-844-3149
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	TANYA YOUNG WILLIAMS
Credential	:
Telephone Number	:	800-844-3149

Provider Enumeration Date	:	03/11/2019
Last Update Date	:	12/09/2019

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