NPIMap

Organization Active NPI

Celebrate Life Recovery Center Phase II, LLC

  • Substance Abuse Rehabilitation Facility
  • North Lauderdale, FL
National Provider Identifier
1417491820
Registry record updated Dec 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
CELEBRATE LIFE RECOVERY CENTER PHASE II, LLC
Practice address
6043 Kimberly Blvd Ste U
North Lauderdale, FL 33068-2826
Phone
(954) 951-6005
Fax
(954) 951-6006
NPI assigned
Dec 5, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2016

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

Authorized official

Name
Keli Kornmiller
Title
Onboarding Supervisor
Phone
(561) 672-8345

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

6043 Kimberly Blvd Ste U
North Lauderdale, FL 33068-2826

Mailing address

4955 NW 84TH Rd
Coral Springs, FL 33067-1973
Phone (954) 951-6005

National Provider Directory

National Provider Directory
Tax ID family
Celebrate Life Recovery Center Phase II LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1480896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480896000000",
    "number": "1417491820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4955 NW 84TH RD",
            "city": "CORAL SPRINGS",
            "state": "FL",
            "postal_code": "330671973",
            "telephone_number": "954-951-6005",
            "fax_number": "954-951-6006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6043 KIMBERLY BLVD STE U",
            "city": "NORTH LAUDERDALE",
            "state": "FL",
            "postal_code": "330682826",
            "telephone_number": "954-951-6005",
            "fax_number": "954-951-6006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CELEBRATE LIFE RECOVERY CENTER PHASE II, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-05",
        "last_updated": "2016-12-05",
        "status": "A",
        "authorized_official_last_name": "KORNMILLER",
        "authorized_official_first_name": "KELI",
        "authorized_official_title_or_position": "ONBOARDING SUPERVISOR",
        "authorized_official_telephone_number": "561-672-8345"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Lauderdale, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2016; 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.