Healthcare Provider Details

I. General information

NPI: 1962035691
Provider Name (Legal Business Name): NAMASTE PSYCHIATRIC RECOVERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2020
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ARCHWAYS 919 NE 13TH STREET
FORT LAUDERDALE FL
33304-3330
US

IV. Provider business mailing address

609 SW 19TH ST
FORT LAUDERDALE FL
33315-2049
US

V. Phone/Fax

Practice location:
  • Phone: 954-763-2030
  • Fax: 954-467-8458
Mailing address:
  • Phone: 754-581-2844
  • Fax: 954-467-8458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. STEPHANIE HALL FORD
Title or Position: PRESIDENT
Credential: APRN
Phone: 754-581-2844