Ambrosia South LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

AMBROSIA SOUTH LLC

Practice address

2010 Ponce de Leon Ave
Units a and H
West Palm Beach, FL 33407

Phone

(561) 578-8600

NPI assigned

Nov 30, 2010

Organization subpart

No

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

Authorized official

Name

Reesa McKenzie

Title

Cfo

Phone

(561) 545-1083

Specialties & licenses 1

Addresses

Other names 1

• Midwest Detox Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1291075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1669774485",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2010 PONCE DE LEON AVE",
            "address_2": "UNITS A AND H",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "33407",
            "telephone_number": "561-578-8600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "222 Picadilly St",
            "address_purpose": "LOCATION",
            "city": "West Palm Beach",
            "state": "FL",
            "postal_code": "334076017",
            "country_code": "US",
            "telephone_number": "561-598-6966",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "AMBROSIA SOUTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-30",
        "last_updated": "2022-07-21",
        "certification_date": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MCKENZIE",
        "authorized_official_first_name": "REESA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "561-545-1083"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midwest Detox",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• 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 Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.