Healthcare Provider Details

I. General information

NPI: 1063171387
Provider Name (Legal Business Name): ACWORTH TREATMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2021
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6060 LAKE ACWORTH DR NW STE K
ACWORTH GA
30101-7358
US

IV. Provider business mailing address

6060 LAKE ACWORTH DR NW STE K
ACWORTH GA
30101-7358
US

V. Phone/Fax

Practice location:
  • Phone: 561-225-9503
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. RENEE LEVINE
Title or Position: COO
Credential:
Phone: 561-225-9503