Provider Demographics
NPI:1073909560
Name:CENTRAL FLORIDA DETOX, LLC
Entity Type:Organization
Organization Name:CENTRAL FLORIDA DETOX, LLC
Other - Org Name:ORLANDO RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSING & CONTRACTING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SURUJON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-300-3120
Mailing Address - Street 1:100 SE 3RD AVE
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33394-0002
Mailing Address - Country:US
Mailing Address - Phone:754-300-3120
Mailing Address - Fax:888-919-4431
Practice Address - Street 1:6000 LAKE ELLENOR DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-4615
Practice Address - Country:US
Practice Address - Phone:754-300-3120
Practice Address - Fax:888-919-4431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-10
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)