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General NPI Number Information
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NPI Number | 1043700578
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Entity Type | Organization
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Legal Business Name | SOUTH BEACH DETOX LLC
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Dates
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Enumeration Date | 05/10/2018
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Last Update Date | 08/12/2021
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Provider Practice Location Address
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Address Line | 85 NW 168TH STREET
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33169-6053
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Country | US
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Telephone | 305-430-6040
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Fax | 305-705-4269
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Provider Business Mailing Address
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Address Line | 16400 NW 2ND AVENUE SUITE 200
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33169-6035
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Country | US
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Telephone | 305-430-6040
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Fax | 305-705-4269
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Authorized Official
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Title or Position | OWNER
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Name | DONNA HURWIT
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Credential | ARNP
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Telephone | 305-992-8117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 001957
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License Number State | FL
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