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NPI Code Detail

MEDICARE: CENTRAL FLORIDA DETOX, LLC

MEDICARE: CENTRAL FLORIDA DETOX, LLC
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
1324500000XSubstance Abuse Rehabilitation Facility
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
3101YA0400XAddiction (Substance Use Disorder) Counselor
4323P00000XPsychiatric Residential Treatment Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073909560
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTRAL FLORIDA DETOX, LLC
Provider Business Mailing Address
First Line : 2200 N COMMERCE PKWY STE 200
Second Line :
City : WESTON
State : FL
Zip : 33326-3258
Country : US
Telephone Number : 754-300-3120
Fax Number : 888-919-4431
Provider Business Practice Location Address
First Line : 6000 LAKE ELLENOR DR
Second Line :
City : ORLANDO
State : FL
Zip : 32809-4615
Country : US
Telephone Number : 754-300-3120
Fax Number : 888-919-4431
Authorized Official
Title or Position : LICENSING & CONTRACTING DIRECTOR
Name : BELINA SURUJON
Credential :
Telephone Number : 305-785-5520
Provider Enumeration Date : 04/10/2015
Last Update Date : 05/11/2026

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Directions to “CENTRAL FLORIDA DETOX, LLC ” Practice Location

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