Provider Demographics
NPI:1689164139
Name:DELRAY HEALTHCARE ASSOCIATES 1 INC
Entity Type:Organization
Organization Name:DELRAY HEALTHCARE ASSOCIATES 1 INC
Other - Org Name:WAVES RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-332-9844
Mailing Address - Street 1:5100 N FEDERAL HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3842
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5100 N FEDERAL HWY STE 100
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3842
Practice Address - Country:US
Practice Address - Phone:954-332-9844
Practice Address - Fax:954-776-9833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility