Basic Information
| Provider Information | |||||||||
| NPI: | 1235400938 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OUR PLACE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 460 S OCEAN DR | ||||||||
| Address2: | |||||||||
| City: | DEERFIELD BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334415125 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4699 N FEDERAL HWY | ||||||||
| Address2: | SUITE 206A | ||||||||
| City: | POMPANO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330646510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8889762379 | ||||||||
| FaxNumber: | 9547196762 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2012 | ||||||||
| LastUpdateDate: | 12/04/2012 | ||||||||
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| AuthorizedOfficialLastName: | FLORES | ||||||||
| AuthorizedOfficialFirstName: | JOSE | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 7542012265 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | 1706AD870001 | FL | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.