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General NPI Number Information
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NPI Number | 1811698152
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Entity Type | Organization
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Legal Business Name | ONYX BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 03/14/2023
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Last Update Date | 11/15/2023
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Provider Practice Location Address
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Address Line | 699 NW AIROSO BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34983-1108
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Country | US
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Telephone | 772-205-3160
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Fax | 772-673-0218
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Provider Business Mailing Address
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Address Line | 699 NW AIROSO BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34983-1108
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Country | US
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Telephone | 772-205-3160
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Fax | 772-673-0218
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Authorized Official
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Title or Position | CEO, OWNER
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Name | MR. SAMUEL PHILIP KESARIS
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Credential |
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Telephone | 954-665-3826
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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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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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