Provider Demographics
NPI:1699153957
Name:LIFE TRACKS TREATMENT CENTER LLC.
Entity type:Organization
Organization Name:LIFE TRACKS TREATMENT CENTER LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:LAZARO
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, LMFT, CAP
Authorized Official - Phone:954-800-4111
Mailing Address - Street 1:100 S MILITARY TRL
Mailing Address - Street 2:SUITE 7
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-3015
Mailing Address - Country:US
Mailing Address - Phone:954-800-4111
Mailing Address - Fax:954-800-4112
Practice Address - Street 1:100 S MILITARY TRL
Practice Address - Street 2:SUITE 7
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-3015
Practice Address - Country:US
Practice Address - Phone:954-800-4111
Practice Address - Fax:954-800-4112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8360101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty