Provider Demographics
NPI:1336970367
Name:FLOIRDA OASIS BAYBERRY LLC
Entity type:Organization
Organization Name:FLOIRDA OASIS BAYBERRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:SOBELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:954-655-6735
Mailing Address - Street 1:431 SE 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-7621
Mailing Address - Country:US
Mailing Address - Phone:954-655-6735
Mailing Address - Fax:954-901-2801
Practice Address - Street 1:717 BAYBERRY DRIVE
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33403
Practice Address - Country:US
Practice Address - Phone:561-249-1174
Practice Address - Fax:954-901-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility