Provider Demographics
NPI:1831516418
Name:HOME DETOX INC
Entity type:Organization
Organization Name:HOME DETOX INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:SHEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN / CAP, RMHCI
Authorized Official - Phone:941-412-3869
Mailing Address - Street 1:530 US 41 BYPASS SO UNIT 12B
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285
Mailing Address - Country:US
Mailing Address - Phone:941-412-3869
Mailing Address - Fax:941-412-3869
Practice Address - Street 1:530 US 41 BYPASS SO
Practice Address - Street 2:UNIT 12B
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285
Practice Address - Country:US
Practice Address - Phone:941-412-3869
Practice Address - Fax:941-412-3869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LMHLILMH11974101YM0800X
FLRN1572552163W00000X
FLCAP2957101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty