Organization
OUR PLACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLA RAJARAM (BILLING MANAGER)
(954) 272-6723
Entity
Organization
Contact information
Practice address
2301 W SAMPLE RD BLDG 4, STE 1B & 2B, POMPANO BEACH, FL 33073-3081
(954) 562-1679
Mailing address
2301 W SAMPLE RD BLDG 4, POMPANO BEACH, FL 33073-3081
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
10/30/2015
Last updated
10/30/2015
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