Provider Demographics
NPI:1295031227
Name:THE TAJ MEMORIAL HEALTH CENTER
Entity Type:Organization
Organization Name:THE TAJ MEMORIAL HEALTH CENTER
Other - Org Name:THE TREATMENT CENTER OF THE PALM BEACHES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-587-7771
Mailing Address - Street 1:PO BOX 541119
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33454-1119
Mailing Address - Country:US
Mailing Address - Phone:561-253-6790
Mailing Address - Fax:561-228-0659
Practice Address - Street 1:4905 LANTANA RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-6915
Practice Address - Country:US
Practice Address - Phone:561-253-6790
Practice Address - Fax:561-228-0659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1550AD590201324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility