Provider Demographics
NPI:1881009405
Name:YAVA ADDICTION SERVICES
Entity Type:Organization
Organization Name:YAVA ADDICTION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-225-3108
Mailing Address - Street 1:13055 NW 42ND STREET
Mailing Address - Street 2:STE 208
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3410
Mailing Address - Country:US
Mailing Address - Phone:305-225-3108
Mailing Address - Fax:305-225-3109
Practice Address - Street 1:13055 NW 42ND STREET
Practice Address - Street 2:STE 208
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3410
Practice Address - Country:US
Practice Address - Phone:305-225-3108
Practice Address - Fax:305-225-3109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health