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General NPI Number Information
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NPI Number | 1750718714
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Entity Type | Organization
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Legal Business Name | TLC RECOVERY CENTER OF S FLORIDA, LLC
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Dates
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Enumeration Date | 10/03/2013
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Last Update Date | 09/13/2021
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Provider Practice Location Address
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Address Line | 2901 W CYPRESS CREEK RD STE 123
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309-1732
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Country | US
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Telephone | 954-915-7444
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Fax | 954-206-0372
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Provider Business Mailing Address
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Address Line | 2901 W CYPRESS CREEK RD STE 123
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309-1732
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Country | US
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Telephone | 954-915-7444
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Fax | 954-206-0372
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Authorized Official
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Title or Position | CEO
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Name | MR. GEDALE FENSTER
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Credential |
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Telephone | 305-725-8790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 1706AD153701
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License Number State | FL
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