Healthcare Provider Details

I. General information

NPI: 1699193300
Provider Name (Legal Business Name): DUKENS PLACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 03/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5727 LINCOLN CIR E
LAKE WORTH FL
33463-6758
US

IV. Provider business mailing address

5727 LINCOLN CIR E
LAKE WORTH FL
33463-6758
US

V. Phone/Fax

Practice location:
  • Phone: 786-565-9370
  • Fax: 786-565-9914
Mailing address:
  • Phone:
  • 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: DUCKENS OXYDE
Title or Position: OWNER
Credential:
Phone: 786-565-9370