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Active
Organization subpart
No

Provider details

NPI number
Authorized official
RALPH HARVEY CEO (LABORATORY DIRECTOR)
(561) 843-4877
Entity
Organization

Contact information

Practice address
2771 HYPOLUXO RD, LAKE WORTH, FL 33462-3826
(954) 560-5238
(888) 510-9071
Mailing address
8908 BRIARWOOD MEADOW LN, BOYNTON BEACH, FL 33473-7816
(954) 560-5238
(888) 510-9071

Taxonomy

Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
10D2068987
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
10D2068987
CLIA
FL
Enumeration date
04/21/2014
Last updated
04/21/2014
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