NPI 1124443346

Libra 85

Organisation Psychiatric Residential Treatment Facility Daytona Beach, FL

Practice location

Address: 624 S Atlantic Ave, Daytona Beach, FL 32118-4510
Phone: (386) 315-0899

Authorised official

Name: Jacek Dygdon
Title: Owner
Phone: (386) 315-0899

Registered specialties

Psychiatric Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 323P00000X Licence AL5675 (FL)

Other Psychiatric Residential Treatment Facility providers in Florida →

Registry record

NPI: 1124443346
Entity type: Organization
NPI issued: 25 Feb 2014
Record last updated: 25 Feb 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.