Provider Demographics
NPI:1770027187
Name:TLC RECOVERY CENTER OF SOUTH FLORIDA
Entity Type:Organization
Organization Name:TLC RECOVERY CENTER OF SOUTH FLORIDA
Other - Org Name:EVOLUTIONS TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEDALE
Authorized Official - Middle Name:M
Authorized Official - Last Name:FENSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-915-7444
Mailing Address - Street 1:2900 W CYPRESS CREEK RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1715
Mailing Address - Country:US
Mailing Address - Phone:954-915-7444
Mailing Address - Fax:954-206-0372
Practice Address - Street 1:2901 W CYPRESS CREEK RD STE 123
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1732
Practice Address - Country:US
Practice Address - Phone:954-915-7444
Practice Address - Fax:954-206-0372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-05
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy