Healthcare Provider Details

I. General information

NPI: 1669089892
Provider Name (Legal Business Name): DAYSPRING TREATMENT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 NW 183RD ST
MIAMI FL
33169-4462
US

IV. Provider business mailing address

14855 S BISCAYNE RIVER DR
MIAMI FL
33168-4932
US

V. Phone/Fax

Practice location:
  • Phone: 786-344-5680
  • Fax:
Mailing address:
  • Phone: 786-344-5680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: YOUNG ARUWA
Title or Position: CEO
Credential:
Phone: 786-344-5680