Provider Demographics
NPI:1366874216
Name:THE LUKENS INSTITUTE. LLC
Entity type:Organization
Organization Name:THE LUKENS INSTITUTE. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUSSEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-266-7682
Mailing Address - Street 1:PO BOX 101716
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91189-1716
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3587 SW CORPORATE PARKWAY
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990
Practice Address - Country:US
Practice Address - Phone:561-296-3507
Practice Address - Fax:561-627-6077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-02
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL598378OtherJOINT COMMISSION ACCREDITATION
FL10D2059608OtherCLIA WAIVER
FL1550AD019901OtherDCF LICENSE- DAY/NIGHT, INTENSIVE OUTPATIENT & OUTPATIENT TREATMENT