Organization
MIDDLE RIVER SOBER LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL KEANE JR. (OWNER)
(908) 783-3923
Entity
Organization
Contact information
Practice address
101 SE 26TH ST, FORT LAUDERDALE, FL 33316-3972
(954) 560-5238
Mailing address
811 SE 2ND AVE, POMPANO BEACH, FL 33060-8405
(954) 560-5238
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
10D2076037
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10D2076037
FL STATE CLIA LICENSE
FL
Enumeration date
06/27/2014
Last updated
06/27/2014
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