Provider Demographics
NPI:1639435076
Name:SOUTH FLORIDA DRUG & ALCOHOL REHAB
Entity Type:Organization
Organization Name:SOUTH FLORIDA DRUG & ALCOHOL REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CROCCO
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:954-696-1121
Mailing Address - Street 1:1915 NE 45TH STREET
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5118
Mailing Address - Country:US
Mailing Address - Phone:954-990-7745
Mailing Address - Fax:954-990-8215
Practice Address - Street 1:1915 NE 45TH STREET
Practice Address - Street 2:SUITE 110
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-5118
Practice Address - Country:US
Practice Address - Phone:954-990-7745
Practice Address - Fax:954-990-8215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1706AD464401251S00000X
FL1706AD464402324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSE5OtherBCBS