Healthcare Provider Details

I. General information

NPI: 1558186023
Provider Name (Legal Business Name): INNER RICHES OSTEOPATHIC MEDICAL ARTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 N ST ANDREWS DR
ORMOND BEACH FL
32174-3838
US

IV. Provider business mailing address

386 S ATLANTIC AVE STE 1117
ORMOND BEACH FL
32176-7143
US

V. Phone/Fax

Practice location:
  • Phone: 240-731-6929
  • Fax:
Mailing address:
  • Phone: 240-731-6929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HADASSAH AARONSON
Title or Position: OWNER
Credential: DO
Phone: 240-731-6929