MEDICARE: ISSACHAR INC

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		FL

General Provider Information

NPI Number	:	1184080830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISSACHAR INC

Provider Business Mailing Address
First Line	:	5460 N STATE ROAD 7
Second Line	:	SUITE 122
City	:	TAMARAC
State	:	FL
Zip	:	33319-2952
Country	:	US
Telephone Number	:	855-756-1097
Fax Number	:	855-962-7614

Provider Business Practice Location Address
First Line	:	5460 N STATE ROAD 7
Second Line	:	SUITE 122
City	:	TAMARAC
State	:	FL
Zip	:	33319-2952
Country	:	US
Telephone Number	:	855-756-1097
Fax Number	:	855-962-7614

Authorized Official
Title or Position	:	LISCENSED RECOVERY COACH
Name	:	MS. LENORA BRINSON
Credential	:	ETC.
Telephone Number	:	855-756-1097

Provider Enumeration Date	:	01/11/2016
Last Update Date	:	01/11/2016

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Directions to “ISSACHAR INC ” Practice Location

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