=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548493380
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEC TREATMENT & TRANSITIONAL CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2009
-----------------------------------------------------
Last Update Date | 10/20/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 KNUTH ROAD SUITE 220
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-336-6078
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 KNUTH ROAD SUITE 220
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-336-6078
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SUBSTANCE ABUSE COUNSELOR
-----------------------------------------------------
Name | MICHAEL ANTHONY MCCALLA
-----------------------------------------------------
Credential | LICENSED COUNSELOR
-----------------------------------------------------
Telephone | 561-336-6078
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number | SW7809
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------