Organization
GREENLIFE INTENSIVE OUTPATIENT PROGRAM, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLA RAJARAM (BILLING MANAGER)
(954) 272-6723
Entity
Organization
Contact information
Practice address
1601 N PALM AVE, SUITE 106, PEMBROKE PINES, FL 33026-3200
(954) 854-9053
Mailing address
282 NW 162ND AVE, PEMBROKE PINES, FL 33028-1147
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
FL
Other
Enumeration date
05/31/2016
Last updated
05/31/2016
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