Provider Demographics
NPI:1538702444
Name:DETOX CENTERS OF AMERICA LLC
Entity Type:Organization
Organization Name:DETOX CENTERS OF AMERICA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-824-7513
Mailing Address - Street 1:208 SE 8TH ST
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1014
Mailing Address - Country:US
Mailing Address - Phone:305-824-7513
Mailing Address - Fax:
Practice Address - Street 1:208 SE 8TH ST
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1014
Practice Address - Country:US
Practice Address - Phone:305-824-7513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-23
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility