Healthcare Provider Details

I. General information

NPI: 1255750006
Provider Name (Legal Business Name): BEACHWAY THERAPY TREATMENT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 NW 1ST AVE
DELRAY BEACH FL
33444-2611
US

IV. Provider business mailing address

137 NW 1ST AVE
DELRAY BEACH FL
33444-2611
US

V. Phone/Fax

Practice location:
  • Phone: 561-865-5896
  • Fax:
Mailing address:
  • Phone: 561-865-5896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number800026636
License Number StateFL

VIII. Authorized Official

Name: MS. OLIVIA HOLMES
Title or Position: CFO
Credential:
Phone: 561-251-8582