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General NPI Number Information
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NPI Number | 1881907061
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Entity Type | Organization
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Legal Business Name | HALLWAY OF LIFE RECOVERY CENTER INC.
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Dates
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Enumeration Date | 07/16/2010
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Last Update Date | 07/16/2010
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Provider Practice Location Address
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Address Line | 137 S SWINTON AVE
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City | DELRAY BEACH
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State | FL
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Zip | 33444-3669
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Country | US
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Telephone | 561-908-6277
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Fax | 561-908-6277
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Provider Business Mailing Address
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Address Line | 23257 STATE ROAD 7 SUITE 204
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City | BOCA RATON
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State | FL
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Zip | 33428-5448
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Country | US
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Telephone | 561-908-6277
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Fax | 561-908-6277
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Authorized Official
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Title or Position | CEO
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Name | LACRESHA HALL
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Credential | M.D.
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Telephone | 561-908-6277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 10D2003348
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License Number State | FL
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