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General NPI Number Information
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NPI Number | 1730680224
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Entity Type | Organization
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Legal Business Name | BROWARD ADDICTION MEDICAL CENTER LLC
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Dates
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Enumeration Date | 02/21/2018
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Last Update Date | 02/21/2018
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Provider Practice Location Address
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Address Line | 3194 W COMMERCIAL BLVD
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City | TAMARAC
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State | FL
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Zip | 33309-3450
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Country | US
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Telephone | 954-507-0591
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Fax |
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Provider Business Mailing Address
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Address Line | 3194 W COMMERCIAL BLVD
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City | TAMARAC
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State | FL
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Zip | 33309-3450
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Country | US
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Telephone | 954-507-0591
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | BRENT ORTNER
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Credential |
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Telephone | 323-608-0401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State | FL
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