Organization
GREENLIFE INTENSIVE OUTPATIENT PROGRAM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ZVI AHARON ITZCHAKI (CEO)
(954) 304-6922
Entity
Organization
Contact information
Practice address
1601 N PALM AVE STE 106, PEMBROKE PINES, FL 33026-3240
(954) 854-3053
Mailing address
1601 N PALM AVE STE 106, PEMBROKE PINES, FL 33026-3240
(954) 304-6922
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
10/29/2013
Last updated
02/03/2021
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