MEDICARE: NEUROSCIENCE RESEARCH INSTITUTE OF FLORIDA, 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
1	320800000X	Mental Illness Community Based Residential Treatment Facility
2	323P00000X	Psychiatric Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8723	OTHER	FL	AGENCY FOR HEALTH CARE ADMINISTRATION

General Provider Information

NPI Number	:	1306437207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROSCIENCE RESEARCH INSTITUTE OF FLORIDA, LLC

Provider Business Mailing Address
First Line	:	2010 PONCE DE LEON AVE UNIT F&G
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-6040
Country	:	US
Telephone Number	:	561-598-6953
Fax Number	:

Provider Business Practice Location Address
First Line	:	2010 PONCE DE LEON AVE UNIT F&G
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-6040
Country	:	US
Telephone Number	:	561-598-6953
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. DANESH ALAM
Credential	:	MD
Telephone Number	:	561-678-8600

Provider Enumeration Date	:	02/02/2021
Last Update Date	:	02/02/2021

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