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General NPI Number Information
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NPI Number | 1316250764
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Entity Type | Organization
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Legal Business Name | PATRIOT HEALTH AND WELLNESS
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Dates
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Enumeration Date | 07/14/2010
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Last Update Date | 07/14/2010
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Provider Practice Location Address
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Address Line | 1701 SE HILLMOOR DR SUITE A-1
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-7552
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Country | US
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Telephone | 772-237-1313
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Fax | 877-637-7509
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Provider Business Mailing Address
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Address Line | 1701 SE HILLMOOR DR SUITE A-1
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-7552
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Country | US
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Telephone | 772-237-1313
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Fax | 877-637-7509
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Authorized Official
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Title or Position | ONWER
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Name | MR. ARASH MOSSAFA
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Credential |
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Telephone | 772-237-1313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State | FL
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