Healthcare Provider Details

I. General information

NPI: 1821812728
Provider Name (Legal Business Name): TIKVAH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6549 RAJOL DR
SEBRING FL
33875-5598
US

IV. Provider business mailing address

18700 OCEAN MIST DR
BOCA RATON FL
33498-4910
US

V. Phone/Fax

Practice location:
  • Phone: 201-334-2865
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ETAN POMERANTZ
Title or Position: COO
Credential: LMSW
Phone: 201-334-2865