Provider Demographics
NPI:1992189633
Name:FLORIDA HOUSE EXPERIENCE
Entity Type:Organization
Organization Name:FLORIDA HOUSE EXPERIENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TITUS
Authorized Official - Middle Name:SIMEUL
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:954-559-6093
Mailing Address - Street 1:505 S FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-4109
Mailing Address - Country:US
Mailing Address - Phone:954-559-6093
Mailing Address - Fax:
Practice Address - Street 1:505 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-4109
Practice Address - Country:US
Practice Address - Phone:954-559-6093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW8493324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility