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General NPI Number Information
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NPI Number | 1992189633
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Entity Type | Organization
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Legal Business Name | FLORIDA HOUSE EXPERIENCE
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Dates
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Enumeration Date | 07/13/2015
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Last Update Date | 07/13/2015
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Provider Practice Location Address
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Address Line | 505 S FEDERAL HWY
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City | DEERFIELD BEACH
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State | FL
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Zip | 33441-4109
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Country | US
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Telephone | 954-559-6093
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Fax |
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Provider Business Mailing Address
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Address Line | 505 S FEDERAL HWY
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City | DEERFIELD BEACH
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State | FL
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Zip | 33441-4109
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Country | US
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Telephone | 954-559-6093
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Fax |
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Authorized Official
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Title or Position | CLINICAL THERAPIST
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Name | DR. TITUS SIMEUL TUCKER
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Credential | ED.D.
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Telephone | 954-559-6093
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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 | ISW8493
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License Number State | FL
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