Healthcare Provider Details

I. General information

NPI: 1588130363
Provider Name (Legal Business Name): THE WAVE INTERNATIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 RANGE RD
CLEARWATER FL
33765-2125
US

IV. Provider business mailing address

28059 US HIGHWAY 19 N STE 205
CLEARWATER FL
33761-2620
US

V. Phone/Fax

Practice location:
  • Phone: 727-205-7077
  • Fax:
Mailing address:
  • Phone: 727-205-2077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
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 Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER WRIGHT FOX
Title or Position: CEO
Credential:
Phone: 310-547-7501