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General NPI Number Information
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NPI Number | 1003272519
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Entity Type | Organization
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Legal Business Name | ULTIMATE LIFESTYLE TRANSFORMATION, LLC
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Dates
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Enumeration Date | 01/13/2016
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Last Update Date | 01/10/2017
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Provider Practice Location Address
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Address Line | 600 HERITAGE DRIVE.
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City | JUPITER
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State | FL
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Zip | 33458
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Country | US
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Telephone | 561-727-9488
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Fax | 561-658-2435
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Provider Business Mailing Address
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Address Line | 309 EAGLETONE ESTATES DRIVE.
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33418
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Country | US
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Telephone | 561-727-9488
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Fax | 561-658-2434
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Authorized Official
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Title or Position | OWNER
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Name | GLENN SANDS
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Credential |
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Telephone | 561-727-9488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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