Healthcare Provider Details

I. General information

NPI: 1548774763
Provider Name (Legal Business Name): NOVUS MEDICAL DETOX CENTER OF WEST PALM BEACH,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2017
Last Update Date: 11/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 54TH ST
WEST PALM BEACH FL
33407-2419
US

IV. Provider business mailing address

9270 ROYAL PALM AVE
NEW PORT RICHEY FL
34654-5018
US

V. Phone/Fax

Practice location:
  • Phone: 727-232-8356
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: BRYN WESCH
Title or Position: CEO
Credential:
Phone: 727-232-8356