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General NPI Number Information
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NPI Number | 1386139699
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Entity Type | Organization
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Legal Business Name | PAS SUBSTANCE ABUSE, INC.
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Dates
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Enumeration Date | 06/28/2018
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Last Update Date | 06/28/2018
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Provider Practice Location Address
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Address Line | 2017 AVENUE D
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City | FORT PIERCE
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State | FL
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Zip | 34950
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Country | US
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Telephone | 772-486-0733
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Fax |
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Provider Business Mailing Address
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Address Line | 2017 AVENUE D
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City | FORT PIERCE
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State | FL
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Zip | 34950
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Country | US
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Telephone | 772-486-0733
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MR. ALBERT PEGOZZI
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Credential |
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Telephone | 772-486-0733
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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 | 1025102
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License Number State | FL
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