Healthcare Provider Details

I. General information

NPI: 1962835488
Provider Name (Legal Business Name): THE BOUGAINVILLA HOUSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1727 SE 4TH AVE
FORT LAUDERDALE FL
33316-2515
US

IV. Provider business mailing address

1721 SE 4TH AVE
FORT LAUDERDALE FL
33316-2515
US

V. Phone/Fax

Practice location:
  • Phone: 954-764-7337
  • Fax: 954-764-6283
Mailing address:
  • Phone: 954-764-7337
  • Fax: 954-764-6283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number1706AD094501
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number1706AD094501
License Number StateFL

VIII. Authorized Official

Name: MS. VERONICA CARTAGENA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 954-764-7337