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General NPI Number Information
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NPI Number | 1164877759
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Entity Type | Organization
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Legal Business Name | SOBER LIVING BY KEYES, LLC
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Dates
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Enumeration Date | 05/02/2016
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Last Update Date | 05/02/2016
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Provider Practice Location Address
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Address Line | 634 EVERGREEN DR
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City | LAKE PARK
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State | FL
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Zip | 33403-3208
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Country | US
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Telephone | 561-889-1027
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Fax |
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Provider Business Mailing Address
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Address Line | 2835 N MILITARY TRL UNIT E
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-2625
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Country | US
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Telephone | 561-889-1027
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KERROULLIO TOUSSAINT
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Credential |
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Telephone | 561-889-1027
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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 |
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