Organization
REVIVE DETOX CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAFAEL A. HERNANDEZ JR. (OWNER)
(772) 828-6992
Entity
Organization
Contact information
Practice address
8489 S FEDERAL HWY # 1, (S. FEDERAL HIGHWAY) STE.16, PORT SAINT LUCIE, FL 34952-3360
(772) 828-6992
Mailing address
344 SW QUIET WOODS, PORT SAINT LUCIE, FL 34953-8230
(772) 828-6992
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
03/03/2014
Last updated
03/07/2014
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