Organization
PORT CHARLOTTE DETOX LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY MEISE (CEO)
(609) 342-9430
Entity
Organization
Contact information
Practice address
3460 DEPEW AVE, PORT CHARLOTTE, FL 33952-7015
(609) 342-9430
Mailing address
3460 DEPEW AVE, PORT CHARLOTTE, FL 33952-7015
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
01/31/2022
Last updated
01/31/2022
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