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Organization
SUD FACILITY OPTIMIZATION, LLC
Active
Organization
SUD FACILITY OPTIMIZATION, LLC
Active
Other names
SUD FAC OPT
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAY BOULDIN MBBS, MD, PHD22 (RESEARCH DIRECTOR)
(321) 989-2187
Entity
Organization
Contact information
Practice address
1030 VENETIAN DR UNIT 202, MELBOURNE, FL 32904-8466
(954) 260-0104
Mailing address
1030 VENETIAN DR UNIT 202, MELBOURNE, FL 32904-8466
(954) 260-0104
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
—
—
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RA0401X
Addiction Medicine (Internal Medicine) Physician
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
261QR1100X
Research Clinic/Center
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
363LA2100X
Acute Care Nurse Practitioner
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
04/04/2022
Last updated
08/06/2022
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