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General NPI Number Information
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NPI Number | 1043676893
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Entity Type | Organization
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Legal Business Name | SOUTHERN PALMS OASIS, INC.
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Dates
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Enumeration Date | 01/10/2016
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Last Update Date | 01/10/2016
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Provider Practice Location Address
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Address Line | 3936 LOWSON BLVD
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City | DELRAY BEACH
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State | FL
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Zip | 33445-5651
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Country | US
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Telephone | 561-632-8712
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Fax |
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Provider Business Mailing Address
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Address Line | 3936 LOWSON BLVD
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City | DELRAY BEACH
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State | FL
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Zip | 33445-5651
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Country | US
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Telephone | 561-632-8712
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, CEO, CFO
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Name | MR. NEIL SIMON
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Credential |
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Telephone | 561-632-8712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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