The Academy at Ambrosia LLC

Primary specialty

Children's Substance Abuse Rehabilitation FacilityTaxonomy code 3245S0500X

Legal business name

THE ACADEMY AT AMBROSIA LLC

Doing business as

The Academy at Ambrosia LLC

Practice address

1091 SW Bayshore Blvd
Port Saint Lucie, FL 34983-2463

Phone

(772) 323-2099

Fax

(561) 578-8601

NPI assigned

Nov 17, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Danesh Alam, MDNPI 1043227200

Title

Ceo

Phone

(630) 390-0042

Specialties & licenses 1

Addresses

Other names 1

• The Academy at Ambrosia LLC Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Danesh A Alam, MD

  • Psychiatry Physician
  • Winfield, IL
  • NPI 1043227200
  NPD Authorized official

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

{
    "created_epoch": "1700179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700179200000",
    "number": "1346015500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 PICADILLY ST",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334076017",
            "telephone_number": "630-390-0042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1091 SW BAYSHORE BLVD",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349832463",
            "telephone_number": "772-323-2099",
            "fax_number": "561-578-8601"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "550 NW University Blvd",
            "address_purpose": "LOCATION",
            "city": "Port Saint Lucie",
            "state": "FL",
            "postal_code": "349862285",
            "country_code": "US",
            "telephone_number": "772-323-2099",
            "fax_number": "561-578-8601",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "THE ACADEMY AT AMBROSIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-17",
        "last_updated": "2023-11-17",
        "certification_date": "2023-11-17",
        "status": "A",
        "authorized_official_last_name": "ALAM",
        "authorized_official_first_name": "DANESH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "630-390-0042",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Academy at Ambrosia LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Children's Substance Abuse Rehabilitation Facility in Port Saint Lucie, FL
• Providers in Port Saint Lucie, FL by specialty
• Children's Substance Abuse Rehabilitation Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2023; 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.