Provider Demographics
NPI:1053389452
Name:ARCHSTONE RECOVERY CENTER
Entity type:Organization
Organization Name:ARCHSTONE RECOVERY CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:OFFIDANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-588-8323
Mailing Address - Street 1:PO BOX 3288
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33465-3288
Mailing Address - Country:US
Mailing Address - Phone:561-588-8323
Mailing Address - Fax:561-275-7998
Practice Address - Street 1:501 W PERRY ST
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-4547
Practice Address - Country:US
Practice Address - Phone:561-588-8323
Practice Address - Fax:561-275-7998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9732101YM0800X
FLME555612084P0800X
FLOS8387208D00000X
FL0950ADA666261QR0405X
FL261QR0405X, 324500000X
FL10D2039250291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No291U00000XLaboratoriesClinical Medical Laboratory