PB Outpatient Services Florida, LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

PB OUTPATIENT SERVICES FLORIDA, LLC

Practice address

112 N Oak St Ste 109
Lantana, FL 33462-3260

Phone

(615) 567-7252

NPI assigned

Jul 27, 2018

Organization subpart

No

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

Authorized official

Name

Robert S. Waggener

Title

Chief Executive Officer

Phone

(615) 567-7253

Specialties & licenses 3

Addresses

Other names 1

• Lucida Treatment Center Doing business as

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

{
    "created_epoch": "1532649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640563200000",
    "number": "1255818639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 207807",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753207807",
            "telephone_number": "561-337-2600",
            "fax_number": "847-329-4900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 N OAK ST STE 109",
            "city": "LANTANA",
            "state": "FL",
            "postal_code": "334623260",
            "telephone_number": "615-567-7252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PB OUTPATIENT SERVICES FLORIDA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-27",
        "last_updated": "2021-12-27",
        "certification_date": "2021-12-27",
        "status": "A",
        "authorized_official_last_name": "WAGGENER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "615-567-7253"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lucida Treatment Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lucida Treatment Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Palm Coast Medical Supplies
• Allison Pantaleon
• Paramount Go LLC
• Steven Marc Pastor, M.S., D.C., DAAPM
• Gautam H Patel, RPH
• Stuart B. Pechter, D.M.D.
• Gabriel Pena
• Elena Maria Perez Hernandez
• Massiel Maria Perez-Ritter, LMHC
• Dailenis Perez

• Substance Abuse Rehabilitation Facility in Lantana, FL
• Providers in Lantana, FL by specialty
• Substance Abuse Rehabilitation Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2021; 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.