Provider Demographics
NPI:1598272098
Name:BEACHSIDE DETOX LLC
Entity Type:Organization
Organization Name:BEACHSIDE DETOX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANNEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SINCAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-901-4923
Mailing Address - Street 1:1101 54TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2419
Mailing Address - Country:US
Mailing Address - Phone:561-365-3758
Mailing Address - Fax:772-448-4029
Practice Address - Street 1:1101 54TH ST
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2419
Practice Address - Country:US
Practice Address - Phone:561-365-3758
Practice Address - Fax:772-448-4029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-05
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCERT-COMP-1001474324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility