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General NPI Number Information
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NPI Number | 1992172340
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Entity Type | Organization
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Legal Business Name | LIGHT OF THE WORLD REHABILITATION & RECOVERY SERVICES LLC
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Dates
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Enumeration Date | 09/01/2015
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Last Update Date | 05/31/2019
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Provider Practice Location Address
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Address Line | 2100 LAKE IDA RD STE 2
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City | DELRAY BEACH
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State | FL
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Zip | 33445-2442
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Country | US
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Telephone | 305-310-6618
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Fax | 561-330-5268
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Provider Business Mailing Address
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Address Line | 2100 LAKE IDA RD STE 2
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City | DELRAY BEACH
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State | FL
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Zip | 33445-2442
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Country | US
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Telephone | 305-310-6618
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. KEVIN BLAINE SCHMIDT
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Credential | LCSW, BACC
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Telephone | 305-310-6618
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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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