Provider Demographics
NPI:1740285196
Name:LEON F. STEWART-HAL S. MARCHMAN CENTER, INC.
Entity type:Organization
Organization Name:LEON F. STEWART-HAL S. MARCHMAN CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CHESTER
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-947-1480
Mailing Address - Street 1:3875 TIGER BAY RD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32124-1063
Mailing Address - Country:US
Mailing Address - Phone:386-947-1328
Mailing Address - Fax:386-947-1323
Practice Address - Street 1:3875 TIGER BAY RD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32124-1063
Practice Address - Country:US
Practice Address - Phone:386-947-1328
Practice Address - Fax:386-947-1323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QCI500X261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder