Healthcare Provider Details

I. General information

NPI: 1225278773
Provider Name (Legal Business Name): PARTNERSHIP FOR A DRUG FREE COMMUNITY OF SOUTH FL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2009
Last Update Date: 03/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3361 BELVEDERE RD STE C
WEST PALM BEACH FL
33406-1540
US

IV. Provider business mailing address

3361 BELVEDERE RD STE C
WEST PALM BEACH FL
33406-1540
US

V. Phone/Fax

Practice location:
  • Phone: 561-693-5299
  • Fax: 561-615-0045
Mailing address:
  • Phone: 561-693-5299
  • Fax: 561-615-0045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number1550AD014601
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1550AD014601
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number1550AD014601
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number1550AD014601
License Number StateFL

VIII. Authorized Official

Name: MRS. DORIS CARROLL
Title or Position: EXECUTIVE DIRECTOR
Credential: M.S., CPP. CAP
Phone: 561-693-5299