Provider Demographics
NPI:1730680224
Name:BROWARD ADDICTION MEDICAL CENTER LLC
Entity type:Organization
Organization Name:BROWARD ADDICTION MEDICAL CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-608-0401
Mailing Address - Street 1:3194 W COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3450
Mailing Address - Country:US
Mailing Address - Phone:954-507-0591
Mailing Address - Fax:
Practice Address - Street 1:3194 W COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33309-3450
Practice Address - Country:US
Practice Address - Phone:954-507-0591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty