Healthcare Provider Details

I. General information

NPI: 1831968171
Provider Name (Legal Business Name): PBG WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 NORTHLAKE BLVD STE 110
PALM BEACH GARDENS FL
33403-1712
US

IV. Provider business mailing address

770 CRESCENT CIR
CANTON GA
30115-4771
US

V. Phone/Fax

Practice location:
  • Phone: 561-307-1801
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: GEOFF SPILLIAS
Title or Position: CEO
Credential:
Phone: 561-307-1801