Provider Demographics
NPI:1023753662
Name:ANTIDOTE AI, LLC
Entity type:Organization
Organization Name:ANTIDOTE AI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:PRILLAMAN
Authorized Official - Suffix:III
Authorized Official - Credentials:RRT, RN
Authorized Official - Phone:786-559-2723
Mailing Address - Street 1:4960 SW 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5544
Mailing Address - Country:US
Mailing Address - Phone:865-592-7237
Mailing Address - Fax:
Practice Address - Street 1:4960 SW 72ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-5544
Practice Address - Country:US
Practice Address - Phone:865-592-7237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
No251B00000XAgenciesCase Management
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No333300000XSuppliersEmergency Response System Companies
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty