MEDICARE: OCEAN BREEZE DETOX 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	324500000X	Substance Abuse Rehabilitation Facility
2	323P00000X	Psychiatric Residential Treatment Facility

General Provider Information

NPI Number	:	1699444760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEAN BREEZE DETOX LLC

Provider Business Mailing Address
First Line	:	1901 W CYPRESS CREEK RD STE 500
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1862
Country	:	US
Telephone Number	:
Fax Number	:	954-337-6238

Provider Business Practice Location Address
First Line	:	1301 POINCIANA DR
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33025-4563
Country	:	US
Telephone Number	:	855-730-4981
Fax Number	:	954-337-6238

Authorized Official
Title or Position	:	CFO
Name	:	MICHAEL BORKOWSKI
Credential	:
Telephone Number	:	954-487-1224

Provider Enumeration Date	:	09/10/2021
Last Update Date	:	10/13/2022

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Directions to “OCEAN BREEZE DETOX LLC ” Practice Location

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