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INTREPID DETOX RESIDENTIAL LLC
NPI 1275176497
Substance Abuse Rehabilitation Facility in Mangonia Park, FL

Active since October 21, 2019CLIA 10D2176100 · Waiver
1120 48TH ST, MANGONIA PARK, FL 33407(866) 871-5111 Get Directions Write a Review

NPPES record last updated: February 11, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Feb 11, 2020, Feb 7, 2020, Jan 7, 2020 and 1 more (4 updates tracked since 2019).

About Intrepid Detox Residential Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

INTREPID DETOX RESIDENTIAL LLC (NPI 1275176497) is a healthcare organization registered as a substance abuse rehabilitation facility in Mangonia Park, Florida and active in the NPI registry since October 2019. The organization holds a CLIA Waiver certificate valid through December 8, 2027 and lists John Nash, Owner, as its authorized official.

NPPES Registry Identity

NPI1275176497
Entity TypeOrganization
Primary Taxonomy324500000X
Legal Business NameINTREPID DETOX RESIDENTIAL LLC
Location Address1120 48TH STMangonia Park, FL 33407-2302
Mailing Address1120 48th StMangonia Park, FL 33407-2302
Phone(866) 871-5111
Organization SubpartNo
Authorized OfficialJohn NashOwner · (866) 871-5111
Enumeration DateOctober 21, 2019
Last NPPES UpdateFebruary 11, 20204 updates tracked since enumeration
✔ NPI 1275176497 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySubstance Abuse Rehabilitation FacilityResidential Treatment Facilities
Taxonomy Code324500000X
Definition
A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.
1120 48TH ST, Mangonia Park, FL 33407
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D2176100

Intrepid Detox Residential LLC · Mangonia Park, FL
Active · expires Dec 8, 2027
CLIA Number10D2176100
Laboratory TypeSubstance Abuse Facility
Certificate Effective DateDecember 9, 2025
Certificate Expiration DateDecember 8, 2027
Laboratory DirectorJohn Pakel
Laboratory Phone(646) 645-7773
Laboratory LocationIntrepid Detox Residential LLC1120 48th Street, Mangonia Park, FL 33407
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SERENITY WAY ASSISTED LIVING
Assisted Living Facility (Assisted Living, Mental Illness)
1120 48TH ST
WEST PALM BEACH, FL 33407
Palm Beach County (561) 629-7450
MANGONIA DETOX PARTNERS, LLC
Substance Abuse Rehabilitation Facility
1120 48TH ST
WEST PALM BEACH, FL 33407
Palm Beach County (561) 717-0486

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Intrepid Detox Residential LLC's NPI number?

The NPI number for Intrepid Detox Residential LLC is 1275176497. It was assigned to this organization in the NPPES registry on October 21, 2019.

Where is Intrepid Detox Residential LLC located?

Intrepid Detox Residential LLC is located at 1120 48th St, Mangonia Park, FL 33407. The listed phone number is (866) 871-5111.

What is Intrepid Detox Residential LLC's specialty?

The primary specialty registered for this NPI is Substance Abuse Rehabilitation Facility with taxonomy code 324500000X.

Does Intrepid Detox Residential LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D2176100) is associated with this NPI, valid through December 8, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Intrepid Detox Residential LLC was last updated on February 11, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.