Healthcare Provider Details

I. General information

NPI: 1457898744
Provider Name (Legal Business Name): PHPTS OF ORMOND BEACH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2017
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 TOMOKA AVE
ORMOND BEACH FL
32174-6133
US

IV. Provider business mailing address

PO BOX 207983
DALLAS TX
75320-7983
US

V. Phone/Fax

Practice location:
  • Phone: 281-506-0831
  • Fax:
Mailing address:
  • Phone: 281-506-0831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SCOTT M. SASSERSON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 931-994-8001