Provider Demographics
NPI:1861897902
Name:LAVIA DETOX AND TRREATMENT CENTER
Entity type:Organization
Organization Name:LAVIA DETOX AND TRREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED CLINICAL SOCIAL WORK
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SACKS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-575-2020
Mailing Address - Street 1:9121 N MILITARY TRL
Mailing Address - Street 2:#205
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-5984
Mailing Address - Country:US
Mailing Address - Phone:561-575-2289
Mailing Address - Fax:561-427-0007
Practice Address - Street 1:9121 N MILITARY TRL
Practice Address - Street 2:#205
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-5984
Practice Address - Country:US
Practice Address - Phone:561-575-2289
Practice Address - Fax:561-427-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-31
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL324500000X
FLSW61351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherOUTPATIENT