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General NPI Number Information
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NPI Number | 1548794480
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Entity Type | Organization
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Legal Business Name | HONEY LAKE CLINIC INC
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Dates
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Enumeration Date | 04/18/2017
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Last Update Date | 09/30/2022
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Provider Practice Location Address
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Address Line | 1449 NW HONEY LAKE RD
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City | GREENVILLE
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State | FL
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Zip | 32331-4069
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Country | US
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Telephone | 954-536-9539
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Fax |
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Provider Business Mailing Address
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Address Line | 13639 ALLAMANDA CIR
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City | PORT CHARLOTTE
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State | FL
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Zip | 33981-3911
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | NICOLA RAJARAM
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Credential |
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Telephone | 954-272-6612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based 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 | FL
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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