Healthcare Provider Details

I. General information

NPI: 1285946350
Provider Name (Legal Business Name): SP BEHAVIORAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 09/30/2010
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: 561-972-4481
Mailing address:
  • Phone: 561-744-0211
  • Fax: 561-972-4481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH24689
License Number StateFL

VIII. Authorized Official

Name: JOHN MCCARTHY
Title or Position: CEO
Credential:
Phone: 561-744-0211