Midwest Detox at Ambrosia LLC Midwest Detox

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

MIDWEST DETOX AT AMBROSIA LLC MIDWEST DETOX

Practice address

2010 Ponce de Leon Ave
West Palm Beach, FL 33407-6040

Phone

(561) 578-8585

Fax

(561) 429-6690

NPI assigned

Sep 20, 2023

Organization subpart

No

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

Authorized official

Name

Danesh Alam, MDNPI 1043227200

Title

Ceo

Phone

(630) 390-0042

Specialties & licenses 1

Addresses

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": "1695168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695340800000",
    "number": "1497533343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 PICADILLY ST",
            "city": "WEST PALM BCH",
            "state": "FL",
            "postal_code": "334076017",
            "telephone_number": "561-578-8600",
            "fax_number": "561-578-8601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2010 PONCE DE LEON AVE",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334076040",
            "telephone_number": "561-578-8585",
            "fax_number": "561-429-6690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST DETOX AT AMBROSIA LLC MIDWEST DETOX",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-20",
        "last_updated": "2023-09-22",
        "certification_date": "2023-09-22",
        "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_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blanca Marinee Midence
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• Peter Midura
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• Midwife360, LLC
• Simone Mighty
• Barbara Mignona, LMHC
• Miguel Fernando Borda, P.a.
• Miguel Fernando Borda, P.a.

• Substance Abuse Rehabilitation Facility in West Palm Beach, FL
• Providers in West Palm Beach, 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 Sep 22, 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.