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General NPI Number Information
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NPI Number | 1417491820
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Entity Type | Organization
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Legal Business Name | CELEBRATE LIFE RECOVERY CENTER PHASE II, LLC
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Dates
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Enumeration Date | 12/05/2016
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Last Update Date | 12/05/2016
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Provider Practice Location Address
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Address Line | 6043 KIMBERLY BLVD STE U
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City | NORTH LAUDERDALE
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State | FL
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Zip | 33068-2826
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Country | US
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Telephone | 954-951-6005
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Fax | 954-951-6006
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Provider Business Mailing Address
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Address Line | 4955 NW 84TH RD
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City | CORAL SPRINGS
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State | FL
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Zip | 33067-1973
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Country | US
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Telephone | 954-951-6005
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Fax | 954-951-6006
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Authorized Official
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Title or Position | ONBOARDING SUPERVISOR
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Name | KELI KORNMILLER
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Credential |
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Telephone | 561-672-8345
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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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