Healthcare Provider Details

I. General information

NPI: 1780194050
Provider Name (Legal Business Name): HRC THE SANCTUARY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

Provider Other Name: IMPERIUM WELLNESS

II. Dates (important events)

Enumeration Date: 10/02/2017
Last Update Date: 10/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8290 N UNIVERSITY DR
TAMARAC FL
33321-1710
US

IV. Provider business mailing address

150 NW 168TH ST STE 200
NORTH MIAMI BEACH FL
33169-6034
US

V. Phone/Fax

Practice location:
  • Phone: 877-723-7117
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomyRehabilitation, Substance Use Disorder
License Number
License Number State

VIII. Authorized Official

Name: ADAM ADLER
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 954-295-7959