MEDICARE: AMBROSIA OF THE PALM BEACHES

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

General Provider Information

NPI Number	:	1376798215
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMBROSIA OF THE PALM BEACHES

Provider Business Mailing Address
First Line	:	2626 LAKE DR
Second Line	:
City	:	SINGER ISLAND
State	:	FL
Zip	:	33404-3846
Country	:	US
Telephone Number	:	215-850-5553
Fax Number	:	772-323-2106

Provider Business Practice Location Address
First Line	:	2626 LAKE DR
Second Line	:
City	:	SINGER ISLAND
State	:	FL
Zip	:	33404-3846
Country	:	US
Telephone Number	:	215-850-5553
Fax Number	:	772-323-2106

Authorized Official
Title or Position	:	CFO
Name	:	REESA MCKENZIE
Credential	:
Telephone Number	:	561-545-1083

Provider Enumeration Date	:	11/19/2008
Last Update Date	:	07/21/2022

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Directions to “AMBROSIA OF THE PALM BEACHES ” Practice Location

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