Healthcare Provider Details

I. General information

NPI: 1376532150
Provider Name (Legal Business Name): THE VILLAGE SOUTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 POINCIANA DR
PEMBROKE PINES FL
33025-4587
US

IV. Provider business mailing address

1633 POINCIANA DR
PEMBROKE PINES FL
33025-4587
US

V. Phone/Fax

Practice location:
  • Phone: 315-573-3784
  • Fax: 305-576-1348
Mailing address:
  • Phone: 315-573-3784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number113AD273613
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number113AD273612
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number113AD273650
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number1113AD273605
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number1113AD273606
License Number StateFL

VIII. Authorized Official

Name: DR. MICHAEL MILLER
Title or Position: DIRECTOR SPECIAL PROJECTS
Credential: PH.D.
Phone: 305-586-4654