Organization
INTREPID DETOX RESIDENTIAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN NASH (OWNER)
(866) 871-5111
Entity
Organization
Contact information
Practice address
1120 48TH ST, MANGONIA PARK, FL 33407-2302
(866) 871-5111
Mailing address
1120 48TH ST, MANGONIA PARK, FL 33407-2302
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
10/21/2019
Last updated
02/11/2020
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