=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891530150
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACE COMPREHENSIVE HEATH AND WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2024
-----------------------------------------------------
Last Update Date | 06/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8937 GULF RUN WAY
-----------------------------------------------------
City | LAKE WORTH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33467-1105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-389-3808
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8937 GULF RUN WAY
-----------------------------------------------------
City | LAKE WORTH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33467-1105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-389-3808
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | APRN- BC, PMHNP- BC
-----------------------------------------------------
Name | SHAUNETTE PHILLIPS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-389-3808
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------