Healthcare Provider Details

I. General information

NPI: 1740804301
Provider Name (Legal Business Name): HEALING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 5TH AVE N
SAINT PETERSBURG FL
33713-7521
US

IV. Provider business mailing address

3800 5TH AVE N
SAINT PETERSBURG FL
33713-7521
US

V. Phone/Fax

Practice location:
  • Phone: 727-367-2273
  • Fax:
Mailing address:
  • Phone: 727-367-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: AMBER CALHOUN
Title or Position: BUSINESS DEVELOPMENT DIRECTOR
Credential:
Phone: 727-367-2273