THE BOUGAINVILLA HOUSE, INC. (NPI# 1700243300) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700243300 |
| Entity Type | Organization |
| Organization Name | THE BOUGAINVILLA HOUSE, INC. |
| Practice Address |
1727 Se 4th Ave Fort Lauderdale FL 33316-2515 |
| Mailing Address |
1721 Se 4th Ave Fort Lauderdale FL 33316-2515 |
| Practice Telephone | 9547647337 |
| Practice Fax Number | 9547646283 |
| Mailing Telephone | 9547647337 |
| Mailing Fax Number | 9547646283 |
| Enumeration Date | 2016-01-27 |
| Last Update Date | 2016-01-27 |
| Authorized Official Name | KELI KORNMILLER (SENIOR CREDENTIALING SPECIALIST) |
| Authorized Official Telephone | 5616728345 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
Ambulatory Health Care Facilities | ||
| Y | 261QR0800X |
Clinic/Center Specialization: Recovery Care |
Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962835488 | The Bougainvilla House, Inc. | Substance Abuse Rehabilitation Facility | 1727 Se 4th Ave, Fort Lauderdale, FL 33316-2515 | 2013-08-20 |
| 1770949075 | The Bougainvilla House, Inc. | Substance Abuse Rehabilitation Facility | 1727 Se 4th Ave, Fort Lauderdale, FL 33316-2515 | 2016-01-04 |
| Street Address |
1727 SE 4TH AVE |
| City | FORT LAUDERDALE |
| State | FL |
| Zip Code | 33316-2515 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962835488 | The Bougainvilla House, Inc. | Substance Abuse Rehabilitation Facility | 1727 Se 4th Ave, Fort Lauderdale, FL 33316-2515 | 2013-08-20 |
| 1770949075 | The Bougainvilla House, Inc. | Substance Abuse Rehabilitation Facility | 1727 Se 4th Ave, Fort Lauderdale, FL 33316-2515 | 2016-01-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366064040 | Jonathan David Ortiz | Behavior Technician | 1717 Se 4 Ave, Fort Lauderdale, FL 33316 | 2020-05-15 |
| 1306311626 | Gateway Recovery Center, LLC | Counselor | 1421 Sw 4th Avenue, Suite B, Fort Lauderdale, FL 33316 | 2018-10-13 |
| 1588141626 | Natan Bastoky | Family Medicine | 1600 S Andrews Ave # Gme, Fort Lauderdale, FL 33316 | 2018-07-22 |
| 1104320126 | Kathleen Kanani Graham | Pharmacist | 1401 S. Federal Highway, Ft. Lauderdale, FL 33316 | 2018-03-23 |
| 1093224271 | Lacosta Therapy, LLC | Behavioral Analyst | 412 Se 15 St., #4, Ft. Lauderdale, FL 33316 | 2017-09-20 |
| 1124560370 | Yulia Rybalka | Pharmacist | 217 Se 10th Street, Ft Lauderdale, FL 33316 | 2016-11-04 |
| 1730635376 | Brian Alexander Reyes | Specialist/Technologist | 303 Se 3rd Ave, Ft Lauderdale, FL 33316 | 2016-09-01 |
| 1649726282 | Jennifer Tabares | Specialist/Technologist | 303 Southeast 3rd Av, Fort Lauderdale, FL 33316 | 2016-09-01 |
| 1609236850 | Diane Nicole Shilling | Nurse Practitioner | 1001 South Andrews Avenue, Suite 100, Ft. Lauderdale, FL 33316 | 2016-03-01 |
| 1396113239 | Victoria Rosado | Adult Companion | 150 Se 12th Street, 401(b), Fort Lauderdale, FL 33316 | 2015-09-09 |
| Find all providers in zip 33316 | ||||
| Taxonomy Code | 261QR0800X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Recovery Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487138939 | Shining Light Peer Services | Clinic/Center | 3030 Powers Ave, Jacksonville, FL 32207-8043 | 2018-09-20 |
| 1962859983 | Miami Beach Holistic Addiction Treatment Center, LLC. | Clinic/Center | 309 23rd St Ste 200c, Miami Beach, FL 33139-1700 | 2016-05-19 |
| 1962865048 | Holistic Will | Clinic/Center | 2500 Quantum Lakes Dr Ste 212, Boynton Beach, FL 33426-8308 | 2016-04-05 |
| 1366782062 | Easy Horizons, LLC | Clinic/Center | 885 Se 6th Ave Ste C, Delray Beach, FL 33483-5184 | 2013-02-18 |
| 1467600205 | Hyperbaric Services of South Florida Inc | Clinic/Center | 8337 Nw 12th St, Suite 101, Doral, FL 33126-1841 | 2008-09-05 |
| 1578178851 | Crossings Addiction Services Inc, The | Clinic/Center | 107 W Main St, Wauchula, FL 33873-2819 | 2020-09-13 |
| 1477103521 | Mccormick Organization, Inc | Clinic/Center | 1355 N Atlantic Ave, Cocoa Beach, FL 32931-3203 | 2019-09-19 |
| 1396222618 | Square 1 Addiction Programs | Clinic/Center | 1212 Court St Ste B, Clearwater, FL 33756-5004 | 2018-07-20 |
| 1902393663 | Helping Hands Recovery Center, LLC | Clinic/Center | 4101 N Andrews Ave Ste 209, Oakland Park, FL 33309-4775 | 2018-04-18 |
| 1851811004 | Recovery Boot Camp, LLC | Clinic/Center | 85 Sw 5th Ave, Delray Beach, FL 33444-2511 | 2017-06-20 |
| Find all providers with the same taxonomy | ||||
| City | FORT LAUDERDALE |
| Zip Code | 33316 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.