Provider Demographics
NPI:1043700578
Name:SOUTH BEACH DETOX LLC
Entity type:Organization
Organization Name:SOUTH BEACH DETOX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HURWIT
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:305-992-8117
Mailing Address - Street 1:16400 NW 2ND AVENUE SUITE 200
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33169-6035
Mailing Address - Country:US
Mailing Address - Phone:305-430-6040
Mailing Address - Fax:305-705-4269
Practice Address - Street 1:85 NW 168TH STREET
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-6053
Practice Address - Country:US
Practice Address - Phone:305-430-6040
Practice Address - Fax:305-705-4269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL001957324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001957OtherDCF STATE LICENSE
FLPROV-001957OtherDCF PROVISIONAL LICENSE NUMBER