NPIMap

Organization Active NPI

Greenlife Intensive Outpatient Program, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Pembroke Pines, FL
National Provider Identifier
1740638717
Registry record updated May 31, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
GREENLIFE INTENSIVE OUTPATIENT PROGRAM, LLC
Practice address
1601 N Palm Ave
Suite 106
Pembroke Pines, FL 33026-3200
Phone
(954) 854-9053
NPI assigned
May 31, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 31, 2016

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

Authorized official

Name
Nicola Rajaram
Title
Billing Manager
Phone
(954) 272-6723

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X FL Primary

Addresses

Primary practice location

1601 N Palm Ave
Suite 106
Pembroke Pines, FL 33026-3200

Mailing address

282 NW 162ND Ave
Pembroke Pines, FL 33028-1147

National Provider Directory

National Provider Directory
Tax ID family
Greenlife Intensive Outpatient Program LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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": "1464652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464652800000",
    "number": "1740638717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "282 NW 162ND AVE",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330281147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 N PALM AVE",
            "address_2": "SUITE 106",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330263200",
            "telephone_number": "954-854-9053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENLIFE INTENSIVE OUTPATIENT PROGRAM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-31",
        "last_updated": "2016-05-31",
        "status": "A",
        "authorized_official_last_name": "RAJARAM",
        "authorized_official_first_name": "NICOLA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "954-272-6723"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pembroke Pines, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 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.