Provider Demographics
NPI:1578264073
Name:DELAND TREATMENT SOLUTIONS, LLC
Entity Type:Organization
Organization Name:DELAND TREATMENT SOLUTIONS, LLC
Other - Org Name:DELAND TREATMENT SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:CRIDER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:386-346-5325
Mailing Address - Street 1:1200 W NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-5069
Mailing Address - Country:US
Mailing Address - Phone:386-346-5325
Mailing Address - Fax:
Practice Address - Street 1:1200 W NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-5069
Practice Address - Country:US
Practice Address - Phone:386-346-5325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness