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General NPI Number Information
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NPI Number | 1962835488
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Entity Type | Organization
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Legal Business Name | THE BOUGAINVILLA HOUSE, INC.
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Dates
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Enumeration Date | 08/20/2013
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 1727 SE 4TH AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-2515
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Country | US
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Telephone | 954-764-7337
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Fax | 954-764-6283
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Provider Business Mailing Address
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Address Line | 1721 SE 4TH AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-2515
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Country | US
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Telephone | 954-764-7337
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Fax | 954-764-6283
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MS. VERONICA CARTAGENA
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Credential |
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Telephone | 954-764-7337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number | 1706AD094501
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 1706AD094501
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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