Provider Demographics
NPI:1952751786
Name:MBR INTERNATIONAL, LLC
Entity Type:Organization
Organization Name:MBR INTERNATIONAL, LLC
Other - Org Name:MANGO BAY RETREAT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-318-7233
Mailing Address - Street 1:1411 N FLAGLER DR
Mailing Address - Street 2:#8900-B
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3404
Mailing Address - Country:US
Mailing Address - Phone:561-318-7233
Mailing Address - Fax:
Practice Address - Street 1:1411 N FLAGLER DR
Practice Address - Street 2:#8900-B
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3404
Practice Address - Country:US
Practice Address - Phone:561-318-7233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5002261QR0405X
FL324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder