Provider Demographics
NPI:1760829311
Name:EAST COAST DRUG TESTING, LLC.
Entity Type:Organization
Organization Name:EAST COAST DRUG TESTING, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEREN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROESSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-408-3929
Mailing Address - Street 1:159 NORTHAMPTON H
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-1744
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:224 DATURA ST
Practice Address - Street 2:SUITE 402
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-5624
Practice Address - Country:US
Practice Address - Phone:561-408-3929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty