Healthcare Provider Details

I. General information

NPI: 1861091431
Provider Name (Legal Business Name): ALOHA DETOX CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 LINTON BLVD BLDG C
DELRAY BEACH FL
33445-6584
US

IV. Provider business mailing address

4800 LINTON BLVD BLDG C
DELRAY BEACH FL
33445-6584
US

V. Phone/Fax

Practice location:
  • Phone: 954-338-8646
  • Fax:
Mailing address:
  • Phone: 954-338-8646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: GOPI BHANDARI
Title or Position: CEO
Credential:
Phone: 954-338-8646