MEDICARE: INTO ACTION TREATMENT, L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility	09504147Z	FL

General Provider Information

NPI Number	:	1013288398
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTO ACTION TREATMENT, L.L.C.

Provider Business Mailing Address
First Line	:	2310 SE 2ND ST
Second Line	:	SUITE 4
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-7280
Country	:	US
Telephone Number	:	561-336-2162
Fax Number	:	561-336-2258

Provider Business Practice Location Address
First Line	:	2310 SE 2ND ST
Second Line	:	SUITE 7
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-7280
Country	:	US
Telephone Number	:	561-336-2162
Fax Number	:	561-336-2258

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	MR. ANDREY ROSSIN
Credential	:
Telephone Number	:	786-942-0502

Provider Enumeration Date	:	01/19/2012
Last Update Date	:	01/19/2012

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