Healthcare Provider Details

I. General information

NPI: 1619405693
Provider Name (Legal Business Name): TEMPLAR RISING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2017
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 COMMERCIAL BLVD. SUITE #200
LAUDERDALE BY THE SEA FL
33308
US

IV. Provider business mailing address

275 COMMERCIAL BLVD. SUITE #200
LAUDERDALE BY THE SEA FL
33308
US

V. Phone/Fax

Practice location:
  • Phone: 954-909-0540
  • Fax: 954-368-7405
Mailing address:
  • Phone: 954-909-0540
  • Fax: 954-368-7405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. HOTSE BART LANGERAAR
Title or Position: CEO
Credential:
Phone: 954-909-0540