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General NPI Number Information
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NPI Number | 1881378180
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Entity Type | Organization
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Legal Business Name | Q SPACE DETOX LLC
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Dates
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Enumeration Date | 06/15/2023
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Last Update Date | 06/15/2023
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Provider Practice Location Address
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Address Line | 412 SW 5TH ST
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City | HOMESTEAD
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State | FL
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Zip | 33030
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Country | US
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Telephone | 561-460-1318
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Fax |
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Provider Business Mailing Address
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Address Line | 1414 N D ST
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City | LAKE WORTH BEACH
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State | FL
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Zip | 33460-1761
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Country | US
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Telephone | 561-460-1318
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DONNA WEINBERGER
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Credential |
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Telephone | 561-460-1318
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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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