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General NPI Number Information
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NPI Number | 1831968171
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Entity Type | Organization
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Legal Business Name | PBG WELLNESS CENTER LLC
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Dates
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Enumeration Date | 12/28/2023
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Last Update Date | 12/28/2023
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Provider Practice Location Address
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Address Line | 3450 NORTHLAKE BLVD STE 110
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33403-1712
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Country | US
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Telephone | 561-307-1801
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Fax |
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Provider Business Mailing Address
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Address Line | 770 CRESCENT CIR
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City | CANTON
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State | GA
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Zip | 30115-4771
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GEOFF SPILLIAS
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Credential |
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Telephone | 561-307-1801
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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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