Provider Demographics
NPI:1487805933
Name:NEW RIVER COMMUNITY MENTAL HEALTH CENTER, INC.
Entity type:Organization
Organization Name:NEW RIVER COMMUNITY MENTAL HEALTH CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:
Authorized Official - Last Name:CHICKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-530-6118
Mailing Address - Street 1:2962 SW 26 TERRACE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DANIA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33312
Mailing Address - Country:US
Mailing Address - Phone:954-530-6118
Mailing Address - Fax:954-530-6419
Practice Address - Street 1:2962 SW 26 TERRACE
Practice Address - Street 2:SUITE 204
Practice Address - City:DANIA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33312
Practice Address - Country:US
Practice Address - Phone:954-530-6118
Practice Address - Fax:954-530-6419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1706AD157802324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility