Organization
THE BOUGAINVILLA HOUSE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELI KORNMILLER (SENIOR CREDENTIALING SPECIALIST)
(561) 672-8345
Entity
Organization
Contact information
Practice address
1727 SE 4TH AVE, FORT LAUDERDALE, FL 33316-2515
(954) 764-7337
(954) 764-6283
Mailing address
1721 SE 4TH AVE, FORT LAUDERDALE, FL 33316-2515
(954) 764-7337
(954) 764-6283
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
261QR0800X
Recovery Care Clinic/Center
Primary
—
—
Other
Enumeration date
01/27/2016
Last updated
01/27/2016
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