Provider Demographics
NPI:1861811655
Name:FLORIDA DETOX AND RECOVERY CENTER, LLC
Entity type:Organization
Organization Name:FLORIDA DETOX AND RECOVERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GEORGEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-877-2304
Mailing Address - Street 1:6804 PORTO FINO CIR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-7139
Mailing Address - Country:US
Mailing Address - Phone:239-332-4700
Mailing Address - Fax:
Practice Address - Street 1:6804 PORTO FINO CIR
Practice Address - Street 2:SUITE 1
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-7139
Practice Address - Country:US
Practice Address - Phone:239-332-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)