MEDICARE: YAVA ADDICTION SERVICES

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1881009405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YAVA ADDICTION SERVICES

Provider Business Mailing Address
First Line	:	13055 NW 42ND STREET
Second Line	:	STE 208
City	:	MIAMI
State	:	FL
Zip	:	33175-3410
Country	:	US
Telephone Number	:	305-225-3108
Fax Number	:	305-225-3109

Provider Business Practice Location Address
First Line	:	13055 NW 42ND STREET
Second Line	:	STE 208
City	:	MIAMI
State	:	FL
Zip	:	33175-3410
Country	:	US
Telephone Number	:	305-225-3108
Fax Number	:	305-225-3109

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	VANESSA LAGO
Credential	:
Telephone Number	:	305-225-3108

Provider Enumeration Date	:	06/23/2014
Last Update Date	:	06/23/2014

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