Healthcare Provider Details

I. General information

NPI: 1861897902
Provider Name (Legal Business Name): LAVIA DETOX AND TRREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2014
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9121 N MILITARY TRL #205
PALM BEACH GARDENS FL
33410-5984
US

IV. Provider business mailing address

9121 N MILITARY TRL #205
PALM BEACH GARDENS FL
33410-5984
US

V. Phone/Fax

Practice location:
  • Phone: 561-575-2289
  • Fax: 561-427-0007
Mailing address:
  • Phone: 561-575-2289
  • Fax: 561-427-0007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW6135
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateFL

VIII. Authorized Official

Name: MRS. SARAH SACKS
Title or Position: OWNER/LICENSED CLINICAL SOCIAL WORK
Credential: LCSW
Phone: 561-575-2020