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General NPI Number Information
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NPI Number | 1346723905
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Entity Type | Organization
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Legal Business Name | THEORY ONE LLC
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Dates
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Enumeration Date | 09/10/2018
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Last Update Date | 06/26/2019
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Provider Practice Location Address
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Address Line | 2655 NORTH OCEAN DRIVE, STE 103
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City | SINGER ISLAND
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State | FL
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Zip | 33404-4794
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Country | US
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Telephone | 561-379-1026
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Fax | 561-379-1027
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Provider Business Mailing Address
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Address Line | PO BOX 746269
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City | ATLANTA
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State | GA
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Zip | 30374-6269
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Country | US
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Telephone | 561-379-1026
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Fax | 561-379-1027
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | GINO CICERCHIA
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Credential |
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Telephone | 561-379-1026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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