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General NPI Number Information
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NPI Number | 1760875827
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Entity Type | Organization
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Legal Business Name | LONDON TREATMENT CENTER OF FLORIDA, LLC
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Dates
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Enumeration Date | 03/13/2015
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1551 FORUM PL STE 300E
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-2307
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Country | US
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Telephone | 561-508-2336
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Fax | 561-693-4922
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Provider Business Mailing Address
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Address Line | 1551 FORUM PL STE 300E
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-2307
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Country | US
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Telephone | 561-508-2336
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Fax | 561-693-4922
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Authorized Official
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Title or Position | OWNER
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Name | JORDI MARTINEZ
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Credential |
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Telephone | 561-307-9336
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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 | 5001
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License Number State | FL
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