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General NPI Number Information
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NPI Number | 1104693787
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Entity Type | Organization
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Legal Business Name | CENTER FOR JEWISH ADDICTION REHABILITATION LLC
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Dates
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Enumeration Date | 12/05/2023
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Last Update Date | 12/19/2023
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Provider Practice Location Address
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Address Line | 5005 E ROBERTS RD
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City | AVON PARK
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State | FL
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Zip | 33825-8727
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Country | US
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Telephone | 201-334-2865
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Fax |
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Provider Business Mailing Address
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Address Line | 18700 OCEAN MIST DR
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City | BOCA RATON
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State | FL
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Zip | 33498-4910
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COO
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Name | ETAN POMERANTZ
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Credential |
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Telephone | 201-334-2865
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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 |
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License Number State |
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