Healthcare Provider Details

I. General information

NPI: 1962321679
Provider Name (Legal Business Name): JADE HOUSE MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5205 VILLAGE BLVD
WEST PALM BEACH FL
33407-7907
US

IV. Provider business mailing address

5205 VILLAGE BLVD
WEST PALM BEACH FL
33407-7907
US

V. Phone/Fax

Practice location:
  • Phone: 561-821-7232
  • Fax:
Mailing address:
  • Phone: 561-821-7232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN VISCIANO
Title or Position: CEO
Credential: CAC
Phone: 917-960-1508