MEDICARE: GUEST HOUSE HOLISTIC WELLNESS CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1134822034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUEST HOUSE HOLISTIC WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	9151 BELLA VITA CIR
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34637-3504
Country	:	US
Telephone Number	:	516-491-0143
Fax Number	:

Provider Business Practice Location Address
First Line	:	9151 BELLA VITA CIR
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34637-3504
Country	:	US
Telephone Number	:	516-491-0143
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANTHONY FRANCO
Credential	:
Telephone Number	:	516-491-0143

Provider Enumeration Date	:	03/22/2023
Last Update Date	:	03/22/2023

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