Healthcare Provider Details

I. General information

NPI: 1043700578
Provider Name (Legal Business Name): SOUTH BEACH DETOX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 NW 168TH ST
NORTH MIAMI BEACH FL
33169-6053
US

IV. Provider business mailing address

16400 NW 2ND AVE STE 203
NORTH MIAMI BEACH FL
33169-6035
US

V. Phone/Fax

Practice location:
  • Phone: 305-430-6040
  • Fax: 305-705-4269
Mailing address:
  • Phone: 305-430-6040
  • Fax: 305-705-4269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number001957
License Number StateFL

VIII. Authorized Official

Name: DONNA HURWIT
Title or Position: OWNER
Credential: ARNP
Phone: 305-430-6040