Healthcare Provider Details

I. General information

NPI: 1083651061
Provider Name (Legal Business Name): SP BEHAVIORAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 SE TEQUESTA TER
TEQUESTA FL
33469-8146
US

IV. Provider business mailing address

11301 SE TEQUESTA TER
TEQUESTA FL
33469-8146
US

V. Phone/Fax

Practice location:
  • Phone: 561-744-0211
  • Fax:
Mailing address:
  • Phone: 561-744-0211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number4462
License Number StateFL

VIII. Authorized Official

Name: JOHN THOMPSON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PHD
Phone: 561-744-0211