Organization
THEORY ONE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GINO CICERCHIA (ADMINISTRATOR)
(561) 379-1026
Entity
Organization
Contact information
Practice address
2655 NORTH OCEAN DRIVE, STE 103, SINGER ISLAND, FL 33404-4794
(561) 379-1026
(561) 379-1027
Mailing address
PO BOX 746269, ATLANTA, GA 30374-6269
(561) 379-1026
(561) 379-1027
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
XX-XXX6998
TIN
FL
Enumeration date
09/10/2018
Last updated
06/26/2019
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