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General NPI Number Information
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NPI Number | 1245699099
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Entity Type | Organization
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Legal Business Name | BOCA DETOX CENTER LLC
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Dates
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Enumeration Date | 02/22/2016
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Last Update Date | 06/05/2019
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Provider Practice Location Address
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Address Line | 899 MEADOWS RD SUITE100
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City | BOCA RATON
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State | FL
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Zip | 33486-2338
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Country | US
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Telephone | 561-921-4769
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Fax | 561-274-6838
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Provider Business Mailing Address
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Address Line | 899 MEADOWS RD SUITE100
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City | BOCA RATON
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State | FL
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Zip | 33486-2338
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Country | US
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Telephone | 561-921-4769
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Fax | 561-274-6838
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Authorized Official
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Title or Position | CFO
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Name | MR. ISAIAH GOLDMAN
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Credential |
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Telephone | 561-921-4769
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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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