Provider Demographics
NPI:1760806764
Name:STEPHANIE'S FAMILY TREATMENT GROUP LLC
Entity Type:Organization
Organization Name:STEPHANIE'S FAMILY TREATMENT GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEXTER
Authorized Official - Middle Name:D
Authorized Official - Last Name:HEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-219-4041
Mailing Address - Street 1:3613 COCONUT RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-3585
Mailing Address - Country:US
Mailing Address - Phone:561-502-0305
Mailing Address - Fax:772-872-5287
Practice Address - Street 1:3613 COCONUT RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-3585
Practice Address - Country:US
Practice Address - Phone:561-502-0305
Practice Address - Fax:772-872-5287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility