Provider Demographics
NPI:1972816965
Name:PALM BEACH OUTPATIENT DETOX, LLC
Entity Type:Organization
Organization Name:PALM BEACH OUTPATIENT DETOX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCANLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-901-0040
Mailing Address - Street 1:7251 W PALMETTO PARK RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3487
Mailing Address - Country:US
Mailing Address - Phone:561-901-0040
Mailing Address - Fax:
Practice Address - Street 1:7251 W PALMETTO PARK RD
Practice Address - Street 2:SUITE 204
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3487
Practice Address - Country:US
Practice Address - Phone:561-901-0040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty