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General NPI Number Information
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NPI Number | 1205377462
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Entity Type | Organization
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Legal Business Name | SOHO WELLNESS INITIATIVE, LLC
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Dates
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Enumeration Date | 03/20/2017
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Last Update Date | 03/20/2017
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Provider Practice Location Address
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Address Line | 4801 S CONGRESS AVE STE 120
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City | PALM SPRINGS
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State | FL
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Zip | 33461-4746
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Country | US
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Telephone | 561-214-7614
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Fax | 561-293-8278
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Provider Business Mailing Address
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Address Line | 4801 S CONGRESS AVE., STE. 120
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City | LAKE WORTH
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State | FL
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Zip | 33461
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Country | US
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Telephone | 561-214-7614
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Fax | 561-293-8278
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Authorized Official
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Title or Position | CEO
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Name | NATASHA KHAN
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Credential |
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Telephone | 561-214-7614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 504735707061
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License Number State | FL
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