Healthcare Provider Details

I. General information

NPI: 1598201444
Provider Name (Legal Business Name): THE RETREAT OF BROWARD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NW 17TH AVE
POMPANO BEACH FL
33069-2814
US

IV. Provider business mailing address

PO BOX 160255
MIAMI FL
33116-0255
US

V. Phone/Fax

Practice location:
  • Phone: 609-509-9533
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number0601
License Number StateFL

VIII. Authorized Official

Name: STEFANIE CUNNINGHAM
Title or Position: AO
Credential:
Phone: 970-846-5816