Provider Demographics
NPI:1669802385
Name:DIVERSE TREATMENT SOLUTIONS LLC
Entity type:Organization
Organization Name:DIVERSE TREATMENT SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:FANALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-596-1602
Mailing Address - Street 1:19495 BISCAYNE BLVD
Mailing Address - Street 2:403
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2318
Mailing Address - Country:US
Mailing Address - Phone:561-350-3888
Mailing Address - Fax:561-509-0015
Practice Address - Street 1:415 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-4931
Practice Address - Country:US
Practice Address - Phone:561-350-3888
Practice Address - Fax:561-509-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder