Provider Demographics
NPI:1821343740
Name:THE GIFT HOUSE INC
Entity Type:Organization
Organization Name:THE GIFT HOUSE INC
Other - Org Name:GIFTHOUSERECOVERY
Other - Org Type:Other Name
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:IVETTE
Authorized Official - Last Name:AYUSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-589-3036
Mailing Address - Street 1:259 NE AIROSO BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-1675
Mailing Address - Country:US
Mailing Address - Phone:877-589-3036
Mailing Address - Fax:
Practice Address - Street 1:259 NE AIROSO BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-1675
Practice Address - Country:US
Practice Address - Phone:877-589-3036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLH11000058533324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility