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General NPI Number Information
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NPI Number | 1942622881
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Entity Type | Organization
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Legal Business Name | EXECUTIVE RANCHES ALCOHOL AND DRUG REHAB CENTER, LLC
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Dates
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Enumeration Date | 01/13/2014
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Last Update Date | 01/13/2014
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Provider Practice Location Address
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Address Line | 13201 MUSTANG TRL
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City | SOUTHWEST RANCHES
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State | FL
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Zip | 33330-3740
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Country | US
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Telephone | 786-412-6372
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Fax |
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Provider Business Mailing Address
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Address Line | 7100 MELALEUCA RD
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City | SOUTHWEST RANCHES
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State | FL
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Zip | 33330-3833
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MGR
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Name | ALEXANDER BILBAO
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Credential |
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Telephone | 786-412-6372
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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