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General NPI Number Information
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NPI Number | 1588090955
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Entity Type | Organization
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Legal Business Name | ONE LAST CHANCE SOBER LIVING, LLC
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Dates
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Enumeration Date | 09/17/2013
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Last Update Date | 09/17/2013
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Provider Practice Location Address
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Address Line | 211 SW 11TH ST
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City | FT LAUDERDALE
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State | FL
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Zip | 33315-1228
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Country | US
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Telephone | 954-691-6483
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Fax |
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Provider Business Mailing Address
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Address Line | 808 SW 2ND ST
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City | FT LAUDERDALE
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State | FL
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Zip | 33312-1716
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Country | US
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Telephone | 954-691-6483
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Fax |
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Authorized Official
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Title or Position | LABORATORY DIRECTOR
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Name | JOEL PIERCE
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Credential |
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Telephone | 954-691-6483
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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 |
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License Number State |
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