THE BOUGAINVILLA HOUSE, INC. (NPI# 1962835488) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962835488 |
| 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 | 2013-08-20 |
| Last Update Date | 2019-02-14 |
| Authorized Official Name | MS. CICI KELLY (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 9547647337 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 324500000X | Substance Abuse Rehabilitation Facility | 1706AD094501 | FL | Residential Treatment Facilities |
| N | 3245S0500X |
Substance Abuse Rehabilitation Facility Specialization: Substance Abuse Treatment, Children |
1706AD094501 | FL | Residential Treatment Facilities |
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 013497000 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700243300 | The Bougainvilla House, Inc. | Clinic/Center | 1727 Se 4th Ave, Fort Lauderdale, FL 33316-2515 | 2016-01-27 |
| 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 |
|---|---|---|---|---|
| 1700243300 | The Bougainvilla House, Inc. | Clinic/Center | 1727 Se 4th Ave, Fort Lauderdale, FL 33316-2515 | 2016-01-27 |
| 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 | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
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| 1770750663 | 3rd Step Recovery Treatment Group, Inc | Clinic/Center | 547 Nw 9th Ave, Suite 9, Fort Lauderdale, FL 33311-8113 | 2008-05-11 |
| 1619584307 | Hope Abundance Behavioral Health LLC | Clinic/Center | 1810 E Oakland Park Blvd Apt 12, Fort Lauderdale, FL 33306-1123 | 2020-09-26 |
| 1922639137 | Michael Boas Pmhnp Pllc | Clinic/Center | 919 Ne 13th St, Fort Lauderdale, FL 33304-2012 | 2020-01-28 |
| 1922563634 | Authentic Integrative Wellness Inc | Clinic/Center | 2003 W Cypress Creek Rd Ste 103, Fort Lauderdale, FL 33309-1834 | 2019-02-06 |
| 1639582661 | Mindful Connections, LLC | Clinic/Center | 3042 N Federal Hwy, Suite 207, Fort Lauderdale, FL 33306-1400 | 2014-06-06 |
| 1023285897 | 3rd Step Mental Health Center Inc | Clinic/Center | 547 Nw 9th Ave, Ste 9, Fort Lauderdale, FL 33311-8113 | 2008-05-12 |
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| 1053912469 | Loves Community Mental Health Inc | Clinic/Center | 2 Nw 30th Ave, Miami, FL 33125 | 2020-11-03 |
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| 1790385342 | New Family Wellness Center Inc | Clinic/Center | 8200 Nw 41st St Ste 200-98, Doral, FL 33166-6205 | 2020-10-31 |
| 1619577475 | Prestige Behavioral Health Center, LLC | Clinic/Center | 7318 W 20th Ave, Hialeah, FL 33016-1855 | 2020-10-29 |
| 1255931101 | Pine Grove Counseling LLC | Clinic/Center | 539 Se Van Loon Ter, Cape Coral, FL 33990-1157 | 2020-10-29 |
| 1831799766 | Mindset Mental Health Services Inc | Clinic/Center | 12485 Sw 137th Ave Ste 109, Miami, FL 33186-4215 | 2020-10-29 |
| 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.