Healthcare Provider Details

I. General information

NPI: 1356884712
Provider Name (Legal Business Name): OUTPATIENT HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2016
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 SE GOLDTREE DR STE D
PORT ST LUCIE FL
34952-7563
US

IV. Provider business mailing address

401 OLD DIXIE HWY UNIT 3539
JUPITER FL
33469-2442
US

V. Phone/Fax

Practice location:
  • Phone: 561-815-2649
  • Fax:
Mailing address:
  • Phone: 561-815-2649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ROMY AMILCA
Title or Position: RCM MANAGER
Credential:
Phone: 772-248-4800