MEDICARE: DELRAY HEALTHCARE ASSOCIATES 1 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

General Provider Information

NPI Number	:	1689164139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELRAY HEALTHCARE ASSOCIATES 1 INC

Provider Business Mailing Address
First Line	:	5100 N FEDERAL HWY STE 100
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-3842
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5100 N FEDERAL HWY STE 100
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-3842
Country	:	US
Telephone Number	:	954-332-9844
Fax Number	:	954-776-9833

Authorized Official
Title or Position	:	CEO
Name	:	MICHELLE WILGER
Credential	:
Telephone Number	:	954-332-9844

Provider Enumeration Date	:	05/10/2018
Last Update Date	:	06/25/2019

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