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General NPI Number Information
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NPI Number | 1750831665
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Entity Type | Organization
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Legal Business Name | PURE ENTERPRISES LLC
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Dates
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Enumeration Date | 10/04/2016
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 633 NE 167TH ST SUITE 1125
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33162-2442
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Country | US
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Telephone | 305-297-8583
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Fax |
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Provider Business Mailing Address
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Address Line | 633 NE 167TH ST SUITE 1125
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33162-2442
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MARIO J ORDUZ
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Credential |
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Telephone | 305-297-8583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | 1301
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License Number State | FL
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