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General NPI Number Information
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NPI Number | 1477095768
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Entity Type | Organization
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Legal Business Name | LET YOUR SOUL EVOLVE, LLC.
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Dates
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Enumeration Date | 11/17/2016
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Last Update Date | 11/17/2016
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Provider Practice Location Address
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Address Line | 4723 W ATLANTIC AVE SUITE A-21
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City | DELRAY BEACH
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State | FL
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Zip | 33445-3895
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Country | US
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Telephone | 561-628-6651
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Fax |
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Provider Business Mailing Address
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Address Line | 4723 W ATLANTIC AVE SUITE A-11
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City | DELRAY BEACH
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State | FL
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Zip | 33445-3895
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | NICOLA RAJARAM
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Credential |
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Telephone | 954-272-6612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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