Healthcare Provider Details

I. General information

NPI: 1417435165
Provider Name (Legal Business Name): SOLACE BEHAVIORAL HEALTH PSYCHIATRIC & SUBSTANCE ABUSE IOP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2018
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8449 COBB RD
BROOKSVILLE FL
34601-8704
US

IV. Provider business mailing address

17222 HOSPITAL BLVD STE 120
BROOKSVILLE FL
34601-8906
US

V. Phone/Fax

Practice location:
  • Phone: 352-678-5550
  • Fax: 352-678-5551
Mailing address:
  • Phone: 352-678-5550
  • Fax: 352-678-5551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: PAIGE GRAY
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 352-678-5550