Provider Demographics
NPI:1134527435
Name:ADDICTIONS BEHAVIORAL HEALTH CENTER OF AMERICA
Entity type:Organization
Organization Name:ADDICTIONS BEHAVIORAL HEALTH CENTER OF AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:KORCOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-288-2555
Mailing Address - Street 1:5201 NE 14TH TER APT 5
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33334-4927
Mailing Address - Country:US
Mailing Address - Phone:954-288-2555
Mailing Address - Fax:
Practice Address - Street 1:1881 NE 26TH ST STE 212
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1400
Practice Address - Country:US
Practice Address - Phone:954-288-2555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility