Provider Demographics
NPI:1669631594
Name:PSYCHIATRIC AND THERAPEUTIC CARE OF FLORIDA
Entity Type:Organization
Organization Name:PSYCHIATRIC AND THERAPEUTIC CARE OF FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-587-7771
Mailing Address - Street 1:PO BOX 7175
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33338-7175
Mailing Address - Country:US
Mailing Address - Phone:954-587-7771
Mailing Address - Fax:954-727-9864
Practice Address - Street 1:5340 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-7058
Practice Address - Country:US
Practice Address - Phone:954-587-7771
Practice Address - Fax:954-727-9864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55819324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility