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General NPI Number Information
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NPI Number | 1518358803
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Entity Type | Organization
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Legal Business Name | HOLISTIX BY THE SEA, LLC
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Dates
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Enumeration Date | 02/09/2015
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Last Update Date | 02/09/2015
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Provider Practice Location Address
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Address Line | 3217 NE 9TH ST
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City | POMPANO BEACH
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State | FL
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Zip | 33062-4069
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Country | US
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Telephone | 954-491-3413
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Fax |
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Provider Business Mailing Address
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Address Line | 803 NW 2ND AVE
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City | POMPANO BEACH
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State | FL
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Zip | 33060-5604
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Country | US
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Telephone | 877-872-7730
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ALAN TYLER
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Credential |
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Telephone | 954-899-4131
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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 | 1706AD706002
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License Number State | FL
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