Provider Demographics
NPI:1760875827
Name:LONDON TREATMENT CENTER OF FLORIDA, LLC
Entity Type:Organization
Organization Name:LONDON TREATMENT CENTER OF FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-307-9336
Mailing Address - Street 1:1551 FORUM PL STE 300E
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2307
Mailing Address - Country:US
Mailing Address - Phone:561-508-2336
Mailing Address - Fax:561-693-4922
Practice Address - Street 1:1551 FORUM PL STE 300E
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2307
Practice Address - Country:US
Practice Address - Phone:561-508-2336
Practice Address - Fax:561-693-4922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5001261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder