Provider Demographics
NPI:1508399056
Name:HONEY LAKE CLINIC INC
Entity Type:Organization
Organization Name:HONEY LAKE CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMISSIONS
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:NACHTWEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-205-0505
Mailing Address - Street 1:13639 ALLAMANDA CIR
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33981-3911
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1450 NW HONEY LAKE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:FL
Practice Address - Zip Code:32331-4068
Practice Address - Country:US
Practice Address - Phone:954-536-9539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-11
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0855X, 320800000X, 323P00000X
FL324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility