Provider Demographics
NPI:1376798215
Name:AMBROSIA OF THE PALM BEACHES
Entity Type:Organization
Organization Name:AMBROSIA OF THE PALM BEACHES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:REESA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-545-1083
Mailing Address - Street 1:2626 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SINGER ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33404-3846
Mailing Address - Country:US
Mailing Address - Phone:215-850-5553
Mailing Address - Fax:772-323-2106
Practice Address - Street 1:2626 LAKE DR
Practice Address - Street 2:
Practice Address - City:SINGER ISLAND
Practice Address - State:FL
Practice Address - Zip Code:33404-3846
Practice Address - Country:US
Practice Address - Phone:215-850-5553
Practice Address - Fax:772-323-2106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility