MEDICARE: GALT OCEAN REHAB, 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	1706AD576801	FL

General Provider Information

NPI Number	:	1922416106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GALT OCEAN REHAB, LLC

Provider Business Mailing Address
First Line	:	4001 N OCEAN DR
Second Line	:	SUITE 305
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-5968
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 N OCEAN DR
Second Line	:	SUITE 305
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-5968
Country	:	US
Telephone Number	:	844-468-1345
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF BILLING SERVICES
Name	:	ADAM SETH RUDO
Credential	:
Telephone Number	:	305-479-8222

Provider Enumeration Date	:	07/31/2014
Last Update Date	:	06/29/2021

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