Healthcare Provider Details

I. General information

NPI: 1215225016
Provider Name (Legal Business Name): PHBH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2011
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4362 NORTHLAKE BLVD SUITE 109
PALM BEACH GARDENS FL
33410-6275
US

IV. Provider business mailing address

19820 N. 7TH STREET SUITE 205, ATTN: FINANCE DEPT
PHOENIX AZ
85024-1688
US

V. Phone/Fax

Practice location:
  • Phone: 561-899-4388
  • Fax: 561-328-6356
Mailing address:
  • Phone: 928-684-4039
  • Fax: 623-581-7624

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: MR. EDWARD DONAHUE
Title or Position: CFO AND AUTHORIZED OFFICIAL
Credential:
Phone: 928-668-4232