The Source Behavioral Health, LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

THE SOURCE BEHAVIORAL HEALTH, LLC

Practice address

150 SW 12TH Ave Ste 491
Pompano Beach, FL 33069-3298

Phone

(888) 207-3177

NPI assigned

Jun 22, 2020

Last updated

Sep 25, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Augustine Crocco, LCSW

Title

Owner/Ceo

Phone

(267) 744-4265

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dana Latheef

  • Mental Health Counselor
  • Pompano Beach, FL
  • NPI 1235705997
  NPD (past)

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

{
    "created_epoch": "1592784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695600000000",
    "number": "1841816204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6278 NORTH FEDERAL HIGHWAY",
            "address_2": "PMB 370",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333081916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 SW 12TH AVE STE 491",
            "city": "POMPANO BEACH",
            "state": "FL",
            "postal_code": "330693298",
            "telephone_number": "888-207-3177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SOURCE BEHAVIORAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-22",
        "last_updated": "2023-09-25",
        "certification_date": "2023-09-25",
        "status": "A",
        "authorized_official_last_name": "CROCCO",
        "authorized_official_first_name": "AUGUSTINE",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "267-744-4265",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Substance Use Disorder Rehabilitation Clinic/Center in Pompano Beach, FL
• Providers in Pompano Beach, FL by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 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.