Provider Demographics
NPI:1346015500
Name:THE ACADEMY AT AMBROSIA LLC
Entity Type:Organization
Organization Name:THE ACADEMY AT AMBROSIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANESH
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-390-0042
Mailing Address - Street 1:222 PICADILLY ST
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-6017
Mailing Address - Country:US
Mailing Address - Phone:630-390-0042
Mailing Address - Fax:
Practice Address - Street 1:1091 SW BAYSHORE BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-2463
Practice Address - Country:US
Practice Address - Phone:772-323-2099
Practice Address - Fax:561-578-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children