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General NPI Number Information
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NPI Number | 1760993430
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Entity Type | Organization
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Legal Business Name | LIBRE BEHAVIORAL HEALTHCARE LLC
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Dates
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Enumeration Date | 10/20/2017
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Last Update Date | 10/20/2017
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Provider Practice Location Address
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Address Line | 3930 S NOVA RD STE 106
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City | PORT ORANGE
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State | FL
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Zip | 32127-9293
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Country | US
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Telephone | 386-492-6894
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Fax | 407-522-9343
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Provider Business Mailing Address
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Address Line | 612 PALMETTO ST
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168-7327
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Country | US
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Telephone | 386-492-6894
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARK NAGRANI
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Credential | MD
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Telephone | 407-522-9919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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