# THE BOUGAINVILLA HOUSE, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770949075
- **Authorized official:** KELI KORNMILLER (SENIOR CREDENTIALING SPECIALIST)
- **Authorized official phone:** (561) 672-8345

## Contact information

- **Practice address:** 1727 SE 4TH AVE, FORT LAUDERDALE, FL 33316-2515
- **Practice address phone:** (954) 764-7337
- **Practice address fax:** (954) 764-6283
- **Mailing address:** 1721 SE 4TH AVE, FORT LAUDERDALE, FL 33316-2515
- **Mailing address phone:** (954) 764-7337
- **Mailing address fax:** (954) 764-6283

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0800X | Recovery Care Clinic/Center | — | NULL | Yes |
| 324500000X | Substance Abuse Rehabilitation Facility | 1706AD094501 | FL | — |

## Other

- **Enumeration date:** 01/04/2016
- **Last updated:** 01/27/2016