Provider Demographics
NPI:1962035691
Name:NAMASTE PSYCHIATRIC RECOVERY INC
Entity Type:Organization
Organization Name:NAMASTE PSYCHIATRIC RECOVERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:HALL
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:754-581-2844
Mailing Address - Street 1:609 SW 19TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33315-2049
Mailing Address - Country:US
Mailing Address - Phone:754-581-2844
Mailing Address - Fax:954-467-8458
Practice Address - Street 1:ARCHWAYS
Practice Address - Street 2:919 NE 13TH STREET
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3330
Practice Address - Country:US
Practice Address - Phone:954-763-2030
Practice Address - Fax:954-467-8458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)