Provider Demographics
NPI:1538500897
Name:SOUTH FLORIDA TREATMENT CENTER
Entity Type:Organization
Organization Name:SOUTH FLORIDA TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:VERBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-842-7578
Mailing Address - Street 1:5509 N MILITARY TRL
Mailing Address - Street 2:APT 513
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-3485
Mailing Address - Country:US
Mailing Address - Phone:610-842-7578
Mailing Address - Fax:
Practice Address - Street 1:3360 GONDOLIER WAY
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33462-3622
Practice Address - Country:US
Practice Address - Phone:610-842-7578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10D2057318324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility