Organization
PB OUTPATIENT SERVICES FLORIDA, LLC
Active
Other names
Lucida Treatment Center
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT S. WAGGENER (CHIEF EXECUTIVE OFFICER)
(615) 567-7253
Entity
Organization
Contact information
Practice address
112 N OAK ST STE 109, LANTANA, FL 33462-3260
(615) 567-7252
Mailing address
PO BOX 207807, DALLAS, TX 75320-7807
(561) 337-2600
(847) 329-4900
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
07/27/2018
Last updated
12/27/2021
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