Libra 85

Primary specialty

Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X

License

AL5675 Issued in FL

Legal business name

LIBRA 85

Practice address

624 S Atlantic Ave
Daytona Beach, FL 32118-4510

Phone

(386) 315-0899

NPI assigned

Feb 25, 2014

Last updated

Feb 25, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jacek Dygdon

Title

Owner

Phone

(386) 315-0899

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1393286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1393286400000",
    "number": "1124443346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "624 S ATLANTIC AVE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321184510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 S ATLANTIC AVE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321184510",
            "telephone_number": "386-315-0899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBRA 85",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-25",
        "last_updated": "2014-02-25",
        "status": "A",
        "authorized_official_last_name": "DYGDON",
        "authorized_official_first_name": "JACEK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "386-315-0899"
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "FL",
            "license": "AL5675",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004518600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Roger K Lewis, MD
• Shealean Lewis, APRN
• Mikhail Lezhak, RPAC
• James Li, MD
• Anna S Liberatore, M.D.
• Libra Healthcare LLC (Medicine Shoppe)
• Andrea Licari-Critchley, LPC, LMHC, NCC, MA
• Mary Cynthia Liebler, RD
• Life Individual Family Enrichment Services (Life)
• Andrea Mae Lilavois, ARNP

• Psychiatric Residential Treatment Facility in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Psychiatric Residential Treatment Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.