Middle River Sober Living

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

10D2076037 Issued in FL

Legal business name

MIDDLE RIVER SOBER LIVING

Practice address

101 SE 26TH St
Fort Lauderdale, FL 33316-3972

Phone

(954) 560-5238

NPI assigned

Jun 27, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Daniel Keane Jr.

Title

Owner

Phone

(908) 783-3923

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1403827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403827200000",
    "number": "1568877561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 SE 2ND AVE",
            "city": "POMPANO BEACH",
            "state": "FL",
            "postal_code": "330608405",
            "telephone_number": "954-560-5238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 SE 26TH ST",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333163972",
            "telephone_number": "954-560-5238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDDLE RIVER SOBER LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-27",
        "last_updated": "2014-06-27",
        "status": "A",
        "authorized_official_last_name": "KEANE",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "908-783-3923",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "FL",
            "license": "10D2076037",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL STATE CLIA LICENSE",
            "identifier": "10D2076037",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Substance Abuse Rehabilitation Facility in Fort Lauderdale, FL
• Providers in Fort Lauderdale, 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 Jun 27, 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.