Healthcare Provider Details

I. General information

NPI: 1467514398
Provider Name (Legal Business Name): SP BEHAVIORAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 03/15/2011
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: 561-575-1445
Mailing address:
  • Phone: 561-744-0211
  • Fax: 561-575-1445

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: STEVE FILTON
Title or Position: SR VP CFO
Credential:
Phone: 610-738-3300