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General NPI Number Information
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NPI Number | 1992221352
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Entity Type | Organization
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Legal Business Name | PEACE OF MIND RECOVERY CENTER INC.
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Dates
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Enumeration Date | 08/17/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4410 W OAKLAND PARK BLVD
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33313
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Country | US
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Telephone | 954-488-9202
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Fax | 954-488-9172
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Provider Business Mailing Address
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Address Line | 4410 W OAKLAND PARK BLVD
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33313-1819
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Country | US
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Telephone | 954-488-9202
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Fax | 954-488-9172
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Authorized Official
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Title or Position | CEO
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Name | KISHMA VICTOR
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Credential | DR
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Telephone | 954-488-9202
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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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