Provider Demographics
NPI:1306218623
Name:OUTREACH TREATMENT CENTER OF FLORIDA LLC
Entity Type:Organization
Organization Name:OUTREACH TREATMENT CENTER OF FLORIDA LLC
Other - Org Name:N/A
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTANA
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER-MANAGER-CEO
Authorized Official - Phone:305-596-4045
Mailing Address - Street 1:9290 SUNSET DR.
Mailing Address - Street 2:SUITE # 106, BLDG. #2
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173
Mailing Address - Country:US
Mailing Address - Phone:305-596-4045
Mailing Address - Fax:305-596-4047
Practice Address - Street 1:9290 SUNSET DR.
Practice Address - Street 2:SUITE # 106, BLDG. #2
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173
Practice Address - Country:US
Practice Address - Phone:305-596-4045
Practice Address - Fax:305-596-4047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-26
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
FLMT 3043251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty