| NPI | 1104376565 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA IACULLO Billing 954-415-8781 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: FL 5001) |
| Enumeration Date | 2016-10-10 |
| Last Update Date | 2022-07-21 |