Provider Demographics
NPI:1336578079
Name:MDG HOLDINGS INTERNATIONAL LLC
Entity Type:Organization
Organization Name:MDG HOLDINGS INTERNATIONAL LLC
Other - Org Name:IN NETWORK DETOX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-678-0078
Mailing Address - Street 1:803 NW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-5604
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1881 NE 26TH ST
Practice Address - Street 2:SUITE 212
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1416
Practice Address - Country:US
Practice Address - Phone:954-678-0078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-04
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1706AD0606013245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children