Provider Demographics
NPI:1245699099
Name:BOCA DETOX CENTER LLC
Entity type:Organization
Organization Name:BOCA DETOX CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ISAIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-921-4769
Mailing Address - Street 1:899 MEADOWS RD
Mailing Address - Street 2:SUITE100
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2338
Mailing Address - Country:US
Mailing Address - Phone:561-921-4769
Mailing Address - Fax:561-274-6838
Practice Address - Street 1:899 MEADOWS RD
Practice Address - Street 2:SUITE100
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2338
Practice Address - Country:US
Practice Address - Phone:561-921-4769
Practice Address - Fax:561-274-6838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Single Specialty