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General NPI Number Information
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NPI Number | 1851729982
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Entity Type | Organization
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Legal Business Name | GREENLIFE INTENSIVE OUTPATIENT PROGRAM LLC
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Dates
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Enumeration Date | 10/29/2013
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Last Update Date | 02/03/2021
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Provider Practice Location Address
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Address Line | 1601 N PALM AVE STE 106
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-3240
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Country | US
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Telephone | 954-854-3053
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 N PALM AVE STE 106
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-3240
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Country | US
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Telephone | 954-304-6922
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ZVI AHARON ITZCHAKI
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Credential |
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Telephone | 954-304-6922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 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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