Provider Demographics
NPI:1851057293
Name:CRC HEALTH TREATMENT CLINICS, LLC
Entity Type:Organization
Organization Name:CRC HEALTH TREATMENT CLINICS, LLC
Other - Org Name:PANHANDLE COMPREHENSIVE TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFONTANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-800-2772
Mailing Address - Street 1:4553 WATKINS ST
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-2511
Mailing Address - Country:US
Mailing Address - Phone:850-800-2772
Mailing Address - Fax:
Practice Address - Street 1:4553 WATKINS ST
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-2511
Practice Address - Country:US
Practice Address - Phone:850-800-2772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-10
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty