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General NPI Number Information
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NPI Number | 1528450202
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Entity Type | Organization
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Legal Business Name | ADDICTION REHAB NATIONWIDE
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Dates
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Enumeration Date | 03/04/2015
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Last Update Date | 03/09/2015
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Provider Practice Location Address
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Address Line | 1625 RENAISSANCE COMMONS BLVD 610
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-8284
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Country | US
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Telephone | 844-279-7170
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Fax |
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Provider Business Mailing Address
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Address Line | 1625 RENAISSANCE COMMONS BLVD 610
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-8284
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Country | US
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Telephone | 561-843-9183
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. FIDEL MODISE
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Credential | CEO
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Telephone | 561-843-9183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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