Healthcare Provider Details

I. General information

NPI: 1053389452
Provider Name (Legal Business Name): ARCHSTONE RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W PERRY ST
LANTANA FL
33462-4547
US

IV. Provider business mailing address

PO BOX 3288
LAKE WORTH FL
33465-3288
US

V. Phone/Fax

Practice location:
  • Phone: 561-588-8323
  • Fax: 561-275-7998
Mailing address:
  • Phone: 561-588-8323
  • Fax: 561-275-7998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME55561
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number0950ADA666
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH9732
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOS8387
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number10D2039250
License Number StateFL
# 7
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateFL

VIII. Authorized Official

Name: JOHN OFFIDANI
Title or Position: OWNER
Credential:
Phone: 561-588-8323