Provider Demographics
NPI:1104286657
Name:CELEBRATE LIFE RECOVERY CENTER PHASE II, LLC
Entity type:Organization
Organization Name:CELEBRATE LIFE RECOVERY CENTER PHASE II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-951-6005
Mailing Address - Street 1:6043 KIMBERLY BLVD
Mailing Address - Street 2:SUITE U
Mailing Address - City:NORTH LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-2829
Mailing Address - Country:US
Mailing Address - Phone:954-951-6005
Mailing Address - Fax:954-951-6006
Practice Address - Street 1:6043 KIMBERLY BLVD
Practice Address - Street 2:SUITE U
Practice Address - City:NORTH LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33068-2829
Practice Address - Country:US
Practice Address - Phone:954-951-6005
Practice Address - Fax:954-951-6006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-26
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty