Basic Information
| Provider Information | |||||||||
| NPI: | 1669631594 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PSYCHIATRIC AND THERAPEUTIC CARE OF FLORIDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7175 | ||||||||
| Address2: | |||||||||
| City: | FT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333387175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545877771 | ||||||||
| FaxNumber: | 9547279864 | ||||||||
| Practice Location | |||||||||
| Address1: | 5340 N FEDERAL HWY | ||||||||
| Address2: | |||||||||
| City: | LIGHTHOUSE POINT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330647058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545877771 | ||||||||
| FaxNumber: | 9547279864 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2008 | ||||||||
| LastUpdateDate: | 06/05/2008 | ||||||||
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| AuthorizedOfficialLastName: | ZIMMER | ||||||||
| AuthorizedOfficialFirstName: | EVAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9545877771 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | ME55819 | FL | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.