=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285024067
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEPPALA CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2015
-----------------------------------------------------
Last Update Date | 01/19/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2200 FLORIDA MANGO RD STE 100
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33409-6448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-313-4562
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2200 FLORIDA MANGO RD STE 100
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33409-6448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CHI M SEPPALA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-313-4562
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number | TBD
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------