Provider Demographics
NPI:1699444760
Name:OCEAN BREEZE DETOX LLC
Entity type:Organization
Organization Name:OCEAN BREEZE DETOX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BORKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-487-1224
Mailing Address - Street 1:1901 W CYPRESS CREEK RD STE 500
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1862
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:954-337-6238
Practice Address - Street 1:1301 POINCIANA DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-4563
Practice Address - Country:US
Practice Address - Phone:855-730-4981
Practice Address - Fax:954-337-6238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-10
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility