Organization
2110 WEST PALM FACILITY,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY HAWKINS (OWNER)
(561) 832-4780
Entity
Organization
Contact information
Practice address
2110 N FLORIDA MANGO RD, WEST PALM BEACH, FL 33409-6492
(561) 404-5871
(561) 318-6413
Mailing address
2110 N FLORIDA MANGO RD, WEST PALM BEACH, FL 33409-6492
(561) 404-5871
(561) 318-6413
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
291U00000X
Clinical Medical Laboratory
10D2032848
FL
Other
Enumeration date
07/24/2015
Last updated
04/14/2016
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