Provider Demographics
NPI:1043892110
Name:REGARD RECOVERY RESIDENTIAL TREATMENT OF FLORIDA, LLC
Entity Type:Organization
Organization Name:REGARD RECOVERY RESIDENTIAL TREATMENT OF FLORIDA, LLC
Other - Org Name:DESTINATION HOPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHELETTI
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:570-332-3060
Mailing Address - Street 1:6460 NW 5TH WAY
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-6112
Mailing Address - Country:US
Mailing Address - Phone:954-771-2091
Mailing Address - Fax:
Practice Address - Street 1:8301 W MCNAB RD
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-3206
Practice Address - Country:US
Practice Address - Phone:954-771-2091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-27
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1047726OtherDCF - RES 1
FL8696OtherAHCA
FL1047727OtherDCF - INPATIENT DETOX