Provider Demographics
NPI:1134644123
Name:QUANTUM DETOX LLC
Entity Type:Organization
Organization Name:QUANTUM DETOX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-998-7500
Mailing Address - Street 1:100 S MILITARY TRL STE 19
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-3031
Mailing Address - Country:US
Mailing Address - Phone:954-998-7500
Mailing Address - Fax:954-990-0535
Practice Address - Street 1:100 S MILITARY TRL STE 19
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-3031
Practice Address - Country:US
Practice Address - Phone:954-998-7500
Practice Address - Fax:954-990-0535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder