Organization
HONEY LAKE CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLA RAJARAM (BILLING MANAGER)
(954) 272-6612
Entity
Organization
Contact information
Practice address
1449 NW HONEY LAKE RD, GREENVILLE, FL 32331-4069
(954) 536-9539
Mailing address
13639 ALLAMANDA CIR, PORT CHARLOTTE, FL 33981-3911
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
FL
Other
Enumeration date
04/18/2017
Last updated
09/30/2022
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