Organization
PHASES DETOX, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE KOHAN (OWNER)
(732) 910-1427
Entity
Organization
Contact information
Practice address
1870 FOREST HILL BLVD, SUITE 204, WEST PALM BEACH, FL 33406-8901
(732) 910-1427
Mailing address
718 FRANKLIN RD, WEST PALM BEACH, FL 33405-4208
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
05/09/2017
Last updated
05/09/2017
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