Provider Demographics
NPI:1972013837
Name:CENTER FOR JEWISH ADDICTION REHABILITATION LLC
Entity Type:Organization
Organization Name:CENTER FOR JEWISH ADDICTION REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:ETAN
Authorized Official - Middle Name:
Authorized Official - Last Name:POMERANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-334-2865
Mailing Address - Street 1:18700 OCEAN MIST DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-4910
Mailing Address - Country:US
Mailing Address - Phone:201-334-2865
Mailing Address - Fax:
Practice Address - Street 1:5731 WOLF LAKE RD
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33875-8056
Practice Address - Country:US
Practice Address - Phone:201-334-2865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-05
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2847520696501324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility