=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548416084
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PALM PARTNERS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2008
-----------------------------------------------------
Last Update Date | 08/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 705 LINTON BLVD UNIT A105
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33444-8160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-454-2960
-----------------------------------------------------
Fax | 561-266-5863
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 160 SE 6TH AVE
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33483-5264
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-455-0750
-----------------------------------------------------
Fax | 561-276-3588
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHEIF EXECUTIVE OFFICER
-----------------------------------------------------
Name | DR. PETER A HARRIGAN
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 561-441-1016
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number | 15550ADF301301
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------