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General NPI Number Information
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NPI Number | 1538500897
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Entity Type | Organization
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Legal Business Name | SOUTH FLORIDA TREATMENT CENTER
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Dates
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Enumeration Date | 07/15/2013
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Last Update Date | 07/15/2013
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Provider Practice Location Address
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Address Line | 3360 GONDOLIER WAY
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City | LAKE WORTH
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State | FL
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Zip | 33462-3622
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Country | US
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Telephone | 610-842-7578
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Fax |
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Provider Business Mailing Address
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Address Line | 5509 N MILITARY TRL APT 513
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City | BOCA RATON
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State | FL
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Zip | 33496-3485
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Country | US
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Telephone | 610-842-7578
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JILL VERBIN
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Credential |
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Telephone | 610-842-7578
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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 | 10D2057318
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License Number State | FL
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