Healthcare Provider Details

I. General information

NPI: 1720317282
Provider Name (Legal Business Name): CELEBRATE LIFE RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2009
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 W DANIA BEACH BLVD
DANIA BEACH FL
33004-3330
US

IV. Provider business mailing address

850 W DANIA BEACH BLVD
DANIA BEACH FL
33004-3330
US

V. Phone/Fax

Practice location:
  • Phone: 954-921-7535
  • Fax: 954-346-5788
Mailing address:
  • Phone: 954-921-7535
  • Fax: 954-346-5788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberME52952
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberME52952
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberME52952
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberME52952
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number2215A
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2215A
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberME52952
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number2215A
License Number StateFL
# 9
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number2215A
License Number StateFL
# 10
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberME52952
License Number StateFL
# 11
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number2215A
License Number StateFL
# 12
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberME52952
License Number StateFL
# 13
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberME52952
License Number StateFL

VIII. Authorized Official

Name: MRS. VALERIE CHANDLER
Title or Position: PRESIDENT
Credential:
Phone: 877-205-2906