Healthcare Provider Details

I. General information

NPI: 1811698152
Provider Name (Legal Business Name): ONYX BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 NW AIROSO BLVD
PORT ST LUCIE FL
34983-1108
US

IV. Provider business mailing address

699 NW AIROSO BLVD
PORT ST LUCIE FL
34983-1108
US

V. Phone/Fax

Practice location:
  • Phone: 772-205-3160
  • Fax: 772-673-0218
Mailing address:
  • Phone: 772-205-3160
  • Fax: 772-673-0218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. SAMUEL PHILIP KESARIS
Title or Position: CEO, OWNER
Credential:
Phone: 954-665-3826