Healthcare Provider Details

I. General information

NPI: 1306218623
Provider Name (Legal Business Name): OUTREACH TREATMENT CENTER OF FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2015
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9290 SUNSET DR. SUITE # 106, BLDG. #2
MIAMI FL
33173
US

IV. Provider business mailing address

9290 SUNSET DR. SUITE # 106, BLDG. #2
MIAMI FL
33173
US

V. Phone/Fax

Practice location:
  • Phone: 305-596-4045
  • Fax: 305-596-4047
Mailing address:
  • Phone: 305-596-4045
  • Fax: 305-596-4047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMT 3043
License Number StateFL

VIII. Authorized Official

Name: MARISSA SANTANA
Title or Position: MANAGER/CEO
Credential: OWNER-MANAGER-CEO
Phone: 305-596-4045