Provider Demographics
NPI:1124440375
Name:NEW ROADS FLORIDA LLC
Entity type:Organization
Organization Name:NEW ROADS FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCHINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-533-4220
Mailing Address - Street 1:230 W TOWNE RIDGE PKWY
Mailing Address - Street 2:SUITE 225
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-2005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12 SE 12TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1845
Practice Address - Country:US
Practice Address - Phone:954-635-2721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder