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General NPI Number Information
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NPI Number | 1992502660
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Entity Type | Organization
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Legal Business Name | SEASIDE WELLNESS OF PALM BEACH LLC
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Dates
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Enumeration Date | 02/28/2025
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 106 BLOSSOM LN
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City | PALM BEACH SHORES
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State | FL
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Zip | 33404-5705
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Country | US
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Telephone | 888-831-4855
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Fax | 949-606-0488
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Provider Business Mailing Address
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Address Line | 621 NW 53RD ST STE 370
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City | BOCA RATON
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State | FL
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Zip | 33487-8241
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Country | US
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Telephone | 978-788-4460
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Fax |
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Authorized Official
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Title or Position | CEO, OWNER
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Name | MR. NICHOLAS PETRILLO
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Credential |
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Telephone | 978-440-3200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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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 | 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 #4
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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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