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General NPI Number Information
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NPI Number | 1558810721
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Entity Type | Organization
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Legal Business Name | DETOX OF DELRAY, LLC
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Dates
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Enumeration Date | 09/28/2016
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Last Update Date | 09/28/2016
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Provider Practice Location Address
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Address Line | 4800 LINTON BLVD C
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City | DELRAY BEACH
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State | FL
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Zip | 33445-6584
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Country | US
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Telephone | 561-637-4766
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Fax | 561-637-2437
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Provider Business Mailing Address
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Address Line | 4800 LINTON BLVD C
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City | DELRAY BEACH
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State | FL
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Zip | 33445-6584
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Country | US
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Telephone | 561-637-4766
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Fax | 561-637-2437
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | PROF. JULIAN FRANK RODRIGUEZ
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Credential | ED.S, M.ED., MCAP
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Telephone | 561-637-4766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 276400000X
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Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
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License Number |
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License Number State |
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