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General NPI Number Information
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NPI Number | 1396506655
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Entity Type | Organization
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Legal Business Name | WAVES OF HOPE EATING DISORDER CARE CENTER LLC
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Dates
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Enumeration Date | 01/23/2024
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Last Update Date | 01/23/2024
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Provider Practice Location Address
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Address Line | 4300 MARSH LANDING BLVD
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-1416
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Country | US
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Telephone | 732-887-7136
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Fax |
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Provider Business Mailing Address
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Address Line | 32 CROSS ST STE 203
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5572
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Country | US
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Telephone | 732-887-7136
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | ELI FISCH
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Credential |
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Telephone | 732-887-7136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health 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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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