Healthcare Provider Details

I. General information

NPI: 1922599885
Provider Name (Legal Business Name): PUR HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2018
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1581 OLD DIXIE HIGHWAY
VERO BEACH FL
32960
US

IV. Provider business mailing address

1581 OLD DIXIE HWY
VERO BEACH FL
32960-3654
US

V. Phone/Fax

Practice location:
  • Phone: 772-971-9197
  • Fax:
Mailing address:
  • Phone: 772-971-9197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: KENNETH L COOPER
Title or Position: CEO
Credential:
Phone: 772-999-8979