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General NPI Number Information
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NPI Number | 1942541180
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Entity Type | Organization
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Legal Business Name | F & L MEDICAL
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Dates
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Enumeration Date | 03/13/2013
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Last Update Date | 09/11/2013
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Provider Practice Location Address
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Address Line | 3450 NORTHLAKE BLVD SUITE 103
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33403-1707
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Country | US
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Telephone | 855-874-2354
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Fax |
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Provider Business Mailing Address
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Address Line | 3450 NORTHLAKE BLVD SUITE 103
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33403-1707
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Country | US
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Telephone | 855-874-2354
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DANIEL FORTUNATO
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Credential |
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Telephone | 855-874-2354
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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 | 1550AD006101
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License Number State | FL
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