Healthcare Provider Details

I. General information

NPI: 1447610142
Provider Name (Legal Business Name): FIRST STEP DETOX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2016
Last Update Date: 04/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 N LAKESIDE CT
WEST PALM BEACH FL
33407-6538
US

IV. Provider business mailing address

2600 QUANTUM BLVD
BOYNTON BEACH FL
33426-8627
US

V. Phone/Fax

Practice location:
  • Phone: 561-865-5896
  • Fax:
Mailing address:
  • Phone: 561-865-5896
  • 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: OLIVIA HOLMES
Title or Position: MGR
Credential:
Phone: 561-251-8582