Intrepid Detox Residential LLC
NPI #1275176497 in Mangonia Park, Florida
Provider Information
- NPI Number
- 1275176497
- Entity Type
- Organization
- Organization Name
- Intrepid Detox Residential LLC
- Primary Specialty
- Substance Abuse Rehabilitation Facility
- Enumeration Date
- Oct 21, 2019
- Last Updated
- Feb 11, 2020
Practice Location
- Address
- 1120 48TH ST
- City
- Mangonia Park
- State
- Florida
- ZIP Code
- 33407-2302
- Phone
- (866) 871-5111
Authorized Official
- Name
- JOHN NASH
- Title
- OWNER
- Phone
- (866) 871-5111
Specialties & Taxonomy Codes
| Specialty |
|---|
| Substance Abuse Rehabilitation Facility |
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