Organization Name: | AMBROSIA SOUTH LLC |
NPI Number: | 1669774485 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GERALD HAFFEY (CEO) |
Mailing Address: | 222 Picadilly St West Palm Beach |
State: | FL US |
Postal Code: | 334076017 |
Phone Number: | 5615986966 |
Fax Number: | |
NPI Enumeration Date: | 11/30/2010 |
NPI Last Update Date: | 08/26/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 324500000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Substance Abuse Rehabilitation Facility |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |