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General NPI Number Information
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NPI Number | 1164234449
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Entity Type | Organization
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Legal Business Name | PREMIER DETOX SERVICES LLC
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Dates
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Enumeration Date | 01/23/2025
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 7870 94TH AVE
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City | VERO BEACH
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State | FL
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Zip | 32967-4200
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Country | US
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Telephone | 772-400-7492
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Fax |
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Provider Business Mailing Address
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Address Line | 7870 94TH AVE
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City | VERO BEACH
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State | FL
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Zip | 32967-4200
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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 | OWNER/DON
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Name | THERESA LUNA
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Credential | RN
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Telephone | 772-400-7492
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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 |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number |
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License Number State | NULL
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Taxonomy #3
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State | NULL
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Taxonomy #4
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State | NULL
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Taxonomy #5
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State | NULL
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Taxonomy #6
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Taxonomy Code | 163WA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
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License Number |
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License Number State | NULL
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Taxonomy #7
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State | NULL
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Taxonomy #8
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State | NULL
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