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General NPI Number Information
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NPI Number | 1487866950
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Entity Type | Organization
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Legal Business Name | NOVUS MEDICAL DETOX CENTER OF PASCO COUNTY, LLC
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 12/07/2016
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Provider Practice Location Address
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Address Line | 9270 ROYAL PALM AVE
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City | NEW PORT RICHEY
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State | FL
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Zip | 34654-5018
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Country | US
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Telephone | 727-232-8356
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Fax | 727-232-8408
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Provider Business Mailing Address
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Address Line | 9270 ROYAL PALM AVE
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City | NEW PORT RICHEY
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State | FL
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Zip | 34654-5018
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Country | US
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Telephone | 727-232-8356
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Fax | 727-232-8408
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Authorized Official
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Title or Position | CFO
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Name | MRS. BRYN WESCH
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Credential |
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Telephone | 727-232-8356
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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 | SR51AD235201
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License Number State | FL
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