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General NPI Number Information
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NPI Number | 1013363175
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Entity Type | Organization
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Legal Business Name | P A S SUBSTANCE ABUSE INC
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Dates
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Enumeration Date | 05/09/2016
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Last Update Date | 05/09/2016
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Provider Practice Location Address
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Address Line | 2021 AVENUE D
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City | FORT PIERCE
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State | FL
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Zip | 34950-2747
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Country | US
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Telephone | 772-486-0733
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Fax | 772-468-0120
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Provider Business Mailing Address
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Address Line | 2021 AVENUE D
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City | FORT PIERCE
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State | FL
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Zip | 34950-2747
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Country | US
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Telephone | 772-486-0733
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Fax | 772-468-0120
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MALISSA BENDER
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Credential |
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Telephone | 772-925-4917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | ADC0136772016
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License Number State | FL
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