Healthcare Provider Details

I. General information

NPI: 1245562008
Provider Name (Legal Business Name): BEACHWAY THERAPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2010
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 N DIXIE HIGHWAY
WEST PALM BEACH FL
33407
US

IV. Provider business mailing address

1700 N DIXIE HIGHWAY
WEST PALM BEACH FL
33407
US

V. Phone/Fax

Practice location:
  • Phone: 561-865-5896
  • Fax: 561-865-5896
Mailing address:
  • Phone: 561-212-1963
  • Fax: 561-865-5896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number1550AD025201
License Number StateFL

VIII. Authorized Official

Name: DENIS HOLMES
Title or Position: CEO
Credential:
Phone: 561-865-5896