| Organization Name: | THE BOUGAINVILLA HOUSE, INC. |
| NPI Number: | 1962835488 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CICI KELLY (CHIEF EXECUTIVE OFFICER) |
| Mailing Address: | 1727 Se 4th Ave Fort Lauderdale |
| State: | FL US |
| Postal Code: | 333162515 |
| Phone Number: | 9547647337 |
| Fax Number: | 9547646283 |
| NPI Enumeration Date: | 08/20/2013 |
| NPI Last Update Date: | 08/17/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 324500000X |
| License Number: | 1706AD094501 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| 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. |