Provider Demographics
NPI:1669909438
Name:ASSURANCE DETOX, LLC
Entity type:Organization
Organization Name:ASSURANCE DETOX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPAOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMHC, CAP, CCSA
Authorized Official - Phone:561-985-3131
Mailing Address - Street 1:400 EXECUTIVE CENTER DR STE 209
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2922
Mailing Address - Country:US
Mailing Address - Phone:561-508-8330
Mailing Address - Fax:561-658-2305
Practice Address - Street 1:5601 CORPORATE WAY
Practice Address - Street 2:SUITE 111
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2025
Practice Address - Country:US
Practice Address - Phone:561-985-3131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5043309775501324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility