Provider Demographics
NPI:1194888248
Name:TREATMENT RESOURCES OF MARGATE
Entity type:Organization
Organization Name:TREATMENT RESOURCES OF MARGATE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP, ADMINSTRATIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-256-8210
Mailing Address - Street 1:6831 NW 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1505
Mailing Address - Country:US
Mailing Address - Phone:954-256-8213
Mailing Address - Fax:954-256-8213
Practice Address - Street 1:1141 SW 12TH AVE
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-4614
Practice Address - Country:US
Practice Address - Phone:954-256-8213
Practice Address - Fax:954-256-8213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA9TOtherBLUE CROSS BLUE SHIELD