Healthcare Provider Details

I. General information

NPI: 1245909407
Provider Name (Legal Business Name): OCEAN BREEZE DETOX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8455 S PALM DR
PEMBROKE PINES FL
33025-4537
US

IV. Provider business mailing address

1901 W CYPRESS CREEK RD STE 500
FORT LAUDERDALE FL
33309-1862
US

V. Phone/Fax

Practice location:
  • Phone: 855-730-4981
  • Fax: 954-337-6238
Mailing address:
  • Phone:
  • Fax: 954-337-6238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MICHAEL BORKOWSKI
Title or Position: CFO
Credential:
Phone: 954-487-1224