Provider Demographics
NPI:1508100900
Name:ANGELS RECOVERY DETOX
Entity Type:Organization
Organization Name:ANGELS RECOVERY DETOX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAFFUTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-746-8232
Mailing Address - Street 1:11576 PIERSON RD
Mailing Address - Street 2:SUITE K4
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8767
Mailing Address - Country:US
Mailing Address - Phone:954-746-8232
Mailing Address - Fax:954-746-8981
Practice Address - Street 1:11576 PIERSON RD
Practice Address - Street 2:SUITE K4
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8767
Practice Address - Country:US
Practice Address - Phone:954-746-8232
Practice Address - Fax:954-746-8981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1550AD608201324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility