=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669118998
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HONOR L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2022
-----------------------------------------------------
Last Update Date | 05/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3289 NE HIGHWAY 17
-----------------------------------------------------
City | ARCADIA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34266-5715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-569-4841
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3289 NE HIGHWAY 17
-----------------------------------------------------
City | ARCADIA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34266-5715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-492-1600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/ CEO
-----------------------------------------------------
Name | TOMANDA NELSON
-----------------------------------------------------
Credential | LCSW-R, CASAC MASTER
-----------------------------------------------------
Telephone | 917-569-4841
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------