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General NPI Number Information
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NPI Number | 1730431222
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Entity Type | Organization
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Legal Business Name | HOLISTIX BY THE SEA
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Dates
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Enumeration Date | 10/08/2012
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Last Update Date | 08/21/2020
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Provider Practice Location Address
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Address Line | 6261 W ATLANTIC BLVD
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City | MARGATE
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State | FL
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Zip | 33063-5128
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Country | US
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Telephone | 856-889-0617
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Fax |
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Provider Business Mailing Address
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Address Line | 6261 W ATLANTIC BLVD
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City | MARGATE
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State | FL
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Zip | 33063-5128
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Country | US
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Telephone | 856-889-0617
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Fax | 856-889-0617
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Authorized Official
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Title or Position | CEO
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Name | ALBERT ROBERT COCCIA III
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Credential |
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Telephone | 856-889-0617
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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 |
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License Number State |
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