Provider Demographics
NPI:1174954739
Name:LIFE CHANGES ADDICTION TREATMENT CENTER OF THE PALM BEACHES
Entity type:Organization
Organization Name:LIFE CHANGES ADDICTION TREATMENT CENTER OF THE PALM BEACHES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT TO CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:RAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-337-8500
Mailing Address - Street 1:900 OSCEOLA DR
Mailing Address - Street 2:SUITE 200 A/B
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-5000
Mailing Address - Country:US
Mailing Address - Phone:561-331-8701
Mailing Address - Fax:772-337-8505
Practice Address - Street 1:900 OSCEOLA DR
Practice Address - Street 2:SUITE 200 A/B
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-5000
Practice Address - Country:US
Practice Address - Phone:561-331-8701
Practice Address - Fax:772-337-8505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder