Provider Demographics
NPI:1437573144
Name:WAY BEYOND DETOX LLC
Entity Type:Organization
Organization Name:WAY BEYOND DETOX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-327-6977
Mailing Address - Street 1:6415 LAKE WORTH RD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33446
Mailing Address - Country:US
Mailing Address - Phone:561-327-6977
Mailing Address - Fax:561-420-0050
Practice Address - Street 1:6415 LAKE WORTH RD
Practice Address - Street 2:SUITE 307
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-2910
Practice Address - Country:US
Practice Address - Phone:561-327-6977
Practice Address - Fax:561-420-0050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-17
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility