MEDICARE: REDEMPTION SOBER HOUSE, 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1578984415
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REDEMPTION SOBER HOUSE, LLC

Provider Business Mailing Address
First Line	:	242 NE 10TH ST
Second Line	:	APT A
City	:	DELRAY BEACH
State	:	FL
Zip	:	33444-4065
Country	:	US
Telephone Number	:	954-746-8232
Fax Number	:	954-746-8231

Provider Business Practice Location Address
First Line	:	243 NE 13TH ST
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33444-4159
Country	:	US
Telephone Number	:	954-746-8232
Fax Number	:	954-746-8231

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	NEISHA ZAFFUTO
Credential	:
Telephone Number	:	954-746-8232

Provider Enumeration Date	:	12/19/2013
Last Update Date	:	12/19/2013

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