Healthcare Provider Details

I. General information

NPI: 1790243640
Provider Name (Legal Business Name): PIVOT TREATMENT AND WELLNESS CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 US 1 STE 3
LAKE PARK FL
33403-3531
US

IV. Provider business mailing address

330 US 1 STE 3
LAKE PARK FL
33403-3531
US

V. Phone/Fax

Practice location:
  • Phone: 800-844-3149
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: TANYA YOUNG WILLIAMS
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 800-844-3149