=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588199673
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE REBOUND INSTITUTE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2017
-----------------------------------------------------
Last Update Date | 04/26/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6853 SW 18TH ST SUITE 210
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33433-7056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-273-2686
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6853 SW 18TH ST SUITE 210
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33433-7056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-273-2686
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER
-----------------------------------------------------
Name | MR. JAYSON WILLIAMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 877-273-2686
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------