Healthcare Provider Details

I. General information

NPI: 1396361010
Provider Name (Legal Business Name): A RENEWED PATH TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 PEPPERGRASS RUN
ROYAL PALM BEACH FL
33411-4233
US

IV. Provider business mailing address

2000 N FLORIDA MANGO RD STE 207
WEST PALM BEACH FL
33409-6443
US

V. Phone/Fax

Practice location:
  • Phone: 561-859-7552
  • Fax: 561-450-5230
Mailing address:
  • Phone: 561-859-7552
  • Fax: 561-450-5230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MONIQUE MARTIN
Title or Position: BILLING MANAGER
Credential:
Phone: 561-727-6196