Provider Demographics
NPI:1093260374
Name:SAFE HARBOUR RECOVERY-BOYNTON, LLC OUTPATIENT
Entity Type:Organization
Organization Name:SAFE HARBOUR RECOVERY-BOYNTON, LLC OUTPATIENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPAOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMHC, NCC, CAP
Authorized Official - Phone:561-899-0930
Mailing Address - Street 1:5601 CORPORATE WAY STE 320
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2043
Mailing Address - Country:US
Mailing Address - Phone:561-899-0930
Mailing Address - Fax:561-232-3484
Practice Address - Street 1:5601 CORPORATE WAY STE 320
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2043
Practice Address - Country:US
Practice Address - Phone:561-899-0930
Practice Address - Fax:561-232-3484
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAFE HARBOUR RECOVERY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5001261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder