Healthcare Provider Details

I. General information

NPI: 1780941112
Provider Name (Legal Business Name): LIFESKILLS SOUTH FLORIDA OUTPATIENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 SE 5TH AVE
DELRAY BEACH FL
33483-5211
US

IV. Provider business mailing address

720 COOL SPRINGS BLVD STE 550
FRANKLIN TN
37067-2645
US

V. Phone/Fax

Practice location:
  • Phone: 954-284-0495
  • Fax: 954-834-5082
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN BRADY
Title or Position: CFO
Credential:
Phone: 615-864-8145