Provider Demographics
NPI:1205215779
Name:BEL CANTO DETOX
Entity Type:Organization
Organization Name:BEL CANTO DETOX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEVI
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-567-7256
Mailing Address - Street 1:3100 E COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4327
Mailing Address - Country:US
Mailing Address - Phone:615-567-7256
Mailing Address - Fax:
Practice Address - Street 1:3100 E COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4327
Practice Address - Country:US
Practice Address - Phone:615-567-7256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EBH ACQUISITION SUBSIDIARY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
APPLIED FOR324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility