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General NPI Number Information
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NPI Number | 1902396138
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Entity Type | Organization
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Legal Business Name | COSTA RICA EXECUTIVE REHAB
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Dates
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Enumeration Date | 05/14/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | CALLE HOJA BLANCA
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City | ESCAZU
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State | SAN JOSE
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Zip | 10201
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Country | CR
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Telephone | 888-445-9293
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Fax |
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Provider Business Mailing Address
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Address Line | 2716 OAK TREE LN
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City | FT LAUDERDALE
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State | FL
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Zip | 33309-6700
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Country | US
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Telephone | 954-328-9777
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | REGIS MOREAU
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Credential |
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Telephone | 888-445-9293
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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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