Organization Name: | EXECUTIVE RANCHES ALCOHOL AND DRUG REHAB CENTER, LLC |
NPI Number: | 1942622881 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ALEXANDER BILBAO (MGR) |
Mailing Address: | 13201 Mustang Trl Southwest Ranches |
State: | FL US |
Postal Code: | 333303740 |
Phone Number: | 7864126372 |
Fax Number: | |
NPI Enumeration Date: | 01/13/2014 |
NPI Last Update Date: | 01/13/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR0405X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rehabilitation, Substance Use Disorder |
Taxonomy Definition: |