Healthcare Provider Details

I. General information

NPI: 1114402195
Provider Name (Legal Business Name): HOLISTIC CARE FOR RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 N MILITARY TRL
WEST PALM BEACH FL
33415-1305
US

IV. Provider business mailing address

655 N MILITARY TRL
WEST PALM BEACH FL
33415-1305
US

V. Phone/Fax

Practice location:
  • Phone: 561-686-0120
  • Fax: 561-686-8073
Mailing address:
  • Phone: 561-686-0120
  • Fax: 561-686-8073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: ANDREW P HOPE
Title or Position: CEO
Credential: MD
Phone: 561-686-8073