Healthcare Provider Details

I. General information

NPI: 1659122703
Provider Name (Legal Business Name): BRIDGE TO UNITY INTERVENTION & RECOVERY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 NE 5TH ST
BOYNTON BEACH FL
33435-3505
US

IV. Provider business mailing address

1851 NE 5TH ST
BOYNTON BEACH FL
33435-3505
US

V. Phone/Fax

Practice location:
  • Phone: 786-610-8632
  • Fax:
Mailing address:
  • Phone: 786-610-8632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN MILLER
Title or Position: OWNER
Credential:
Phone: 786-610-8632