Provider Demographics
NPI:1073009148
Name:EMPIRE DETOX, LLC
Entity Type:Organization
Organization Name:EMPIRE DETOX, LLC
Other - Org Name:EMPIRE DETOX
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KAISER
Authorized Official - Suffix:
Authorized Official - Credentials:CAC
Authorized Official - Phone:561-674-2696
Mailing Address - Street 1:3000 NW 101ST LN STE 101-A
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-3930
Mailing Address - Country:US
Mailing Address - Phone:844-533-3869
Mailing Address - Fax:561-370-7899
Practice Address - Street 1:3000 NW 101ST LN STE 101-A
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065
Practice Address - Country:US
Practice Address - Phone:844-533-3869
Practice Address - Fax:561-370-7899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-02
Last Update Date:2019-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder