Organization
WAY BEYOND DETOX
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA IACULLO (BILLING DIRECTOR)
(561) 404-5872
Entity
Organization
Contact information
Practice address
6415 LAKE WORTH RD, 102, GREENACRES, FL 33463-2910
(561) 404-5872
Mailing address
6415 LAKE WORTH RD, 102, GREENACRES, FL 33463-2910
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
01/22/2015
Last updated
01/22/2015
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