Healthcare Provider Details

I. General information

NPI: 1760063242
Provider Name (Legal Business Name): GIA ADDICTION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 BISCAYNE BLVD STE 203
MIAMI FL
33132-1449
US

IV. Provider business mailing address

1501 BISCAYNE BLVD STE 203
MIAMI FL
33132-1449
US

V. Phone/Fax

Practice location:
  • Phone: 786-652-2434
  • Fax: 305-847-2320
Mailing address:
  • Phone: 786-652-2434
  • Fax: 305-847-2320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER JOHNSTON
Title or Position: OFFICE MANAGER
Credential:
Phone: 954-232-4856