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General NPI Number Information
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NPI Number | 1639539349
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Entity Type | Organization
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Legal Business Name | SANCTUARY OF PALM BEACH COUNTY LLC
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Dates
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Enumeration Date | 02/24/2016
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Last Update Date | 03/01/2016
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Provider Practice Location Address
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Address Line | 350 CAMINO GARDENS BLVD SUITE 106
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City | BOCA RATON
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State | FL
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Zip | 33432-5846
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Country | US
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Telephone | 855-345-3334
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Fax |
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Provider Business Mailing Address
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Address Line | 350 CAMINO GARDENS BLVD SUITE 106
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City | BOCA RATON
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State | FL
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Zip | 33432-5846
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Country | US
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Telephone | 855-345-3334
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MR. DEREK MARTIN
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Credential | COO
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Telephone | 561-279-5221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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