1801040860 NPI number — DRUG TESTING AND COUNSELING SERVICES

Table of content: (NPI 1801040860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801040860 NPI number — DRUG TESTING AND COUNSELING SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRUG TESTING AND COUNSELING SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COMPLETE HEALTH WELLNESS AND RECOVERY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801040860
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2677 FOREST HILL BLVD
Provider Second Line Business Mailing Address:
STE 102
Provider Business Mailing Address City Name:
WEST PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33406-5949
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-433-0123
Provider Business Mailing Address Fax Number:
561-967-3484

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2677 FOREST HILL BLVD
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33406-5949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-433-0123
Provider Business Practice Location Address Fax Number:
561-967-3484
Provider Enumeration Date:
11/04/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GILLESPIE
Authorized Official First Name:
LAUREN
Authorized Official Middle Name:
ELIZABETH
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
561-433-0123

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: PY0005314 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: CH9406 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)