Provider Demographics
NPI:1497136717
Name:S K KOTEI CONSULTANTS LLC
Entity Type:Organization
Organization Name:S K KOTEI CONSULTANTS LLC
Other - Org Name:LIFE SOLUTIONS OUTPATIENT NORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SITE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:KOTEI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, CPH, CAP
Authorized Official - Phone:850-583-5388
Mailing Address - Street 1:1347 E TENNESSEE ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5107
Mailing Address - Country:US
Mailing Address - Phone:850-583-5388
Mailing Address - Fax:850-583-5388
Practice Address - Street 1:1347 E TENNESSEE ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5107
Practice Address - Country:US
Practice Address - Phone:850-583-5388
Practice Address - Fax:850-583-5388
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFE SOLUTIONS OUTPATIENT CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0237AD383201324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility