Provider Demographics
NPI:1609132844
Name:ALTERNATIVE IOP TREATMENT
Entity Type:Organization
Organization Name:ALTERNATIVE IOP TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOLDFARB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-945-8384
Mailing Address - Street 1:1590 NE 162ND ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4759
Mailing Address - Country:US
Mailing Address - Phone:305-945-8384
Mailing Address - Fax:305-940-2888
Practice Address - Street 1:1590 NE 162ND ST
Practice Address - Street 2:SUITE 300
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4759
Practice Address - Country:US
Practice Address - Phone:305-945-8384
Practice Address - Fax:305-940-2888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1113AD972701324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility