Provider Demographics
NPI:1972324002
Name:A NEW VISION TREATMENT CENTER, LLC
Entity type:Organization
Organization Name:A NEW VISION TREATMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FAWZI
Authorized Official - Middle Name:
Authorized Official - Last Name:FAROUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-305-9638
Mailing Address - Street 1:18459 PINES BLVD # 410
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-1400
Mailing Address - Country:US
Mailing Address - Phone:561-305-9368
Mailing Address - Fax:
Practice Address - Street 1:6221 GOODLAND AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3023
Practice Address - Country:US
Practice Address - Phone:310-600-5633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder