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General NPI Number Information
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NPI Number | 1457898744
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Entity Type | Organization
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Legal Business Name | PHPTS OF ORMOND BEACH, LLC
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Dates
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Enumeration Date | 01/24/2017
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Last Update Date | 03/07/2022
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Provider Practice Location Address
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Address Line | 515 TOMOKA AVE
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City | ORMOND BEACH
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State | FL
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Zip | 32174-6133
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Country | US
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Telephone | 281-506-0831
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 207983
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City | DALLAS
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State | TX
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Zip | 75320-7983
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Country | US
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Telephone | 281-506-0831
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | SCOTT M. SASSERSON
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Credential |
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Telephone | 931-994-8001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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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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