Provider Demographics
NPI:1609267384
Name:BOCA DETOX CENTER LLC
Entity Type:Organization
Organization Name:BOCA DETOX CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ISAIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:561-271-5199
Mailing Address - Street 1:899 MEADOWS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2338
Mailing Address - Country:US
Mailing Address - Phone:561-271-5199
Mailing Address - Fax:561-274-6838
Practice Address - Street 1:899 MEADOWS RD STE 100
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2338
Practice Address - Country:US
Practice Address - Phone:561-271-5199
Practice Address - Fax:561-274-6838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Single Specialty