Healthcare Provider Details

I. General information

NPI: 1649098302
Provider Name (Legal Business Name): RIVER HOUSE WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 10/04/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650-3670 NE INDIAN RIVER DR
JENSEN BEACH FL
34957-4116
US

IV. Provider business mailing address

3650-3670 NE INDIAN RIVER DR
JENSEN BEACH FL
34957-4116
US

V. Phone/Fax

Practice location:
  • Phone: 772-946-1665
  • Fax:
Mailing address:
  • Phone: 772-946-1665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DOUG PROCTOR
Title or Position: OWNER
Credential:
Phone: 772-946-1665