MEDICARE: CENTER FOR JEWISH ADDICTION REHABILITATION LLC

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	2847520696501	FL

General Provider Information

NPI Number	:	1972013837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR JEWISH ADDICTION REHABILITATION LLC

Provider Business Mailing Address
First Line	:	18700 OCEAN MIST DR
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33498-4910
Country	:	US
Telephone Number	:	201-334-2865
Fax Number	:

Provider Business Practice Location Address
First Line	:	5731 WOLF LAKE RD
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33875-8056
Country	:	US
Telephone Number	:	201-334-2865
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	MR. ETAN POMERANTZ
Credential	:
Telephone Number	:	201-334-2865

Provider Enumeration Date	:	10/05/2017
Last Update Date	:	02/08/2023

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