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General NPI Number Information
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NPI Number | 1962024539
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Entity Type | Organization
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Legal Business Name | BEACHES BAR & CAFE
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Dates
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Enumeration Date | 05/17/2020
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Last Update Date | 12/17/2020
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Provider Practice Location Address
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Address Line | 840 US HIGHWAY 1 STE 435C
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City | N PALM BEACH
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State | FL
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Zip | 33408-3829
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Country | US
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Telephone | 561-294-7741
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Fax | 561-805-1097
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Provider Business Mailing Address
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Address Line | 4597 ARTHUR ST
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33418-5733
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Country | US
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Telephone | 561-294-7741
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Fax | 561-294-7741
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Authorized Official
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Title or Position | CEO/FOUNDER
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Name | MS. AYANNA BABCOCK SUTHERLAND
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Credential | PCT
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Telephone | 561-294-5711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335G00000X
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Taxonomy Name | Medical Foods Supplier
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License Number |
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License Number State |
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