MEDICARE: A RENEWED PATH TREATMENT CENTER

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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1396361010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A RENEWED PATH TREATMENT CENTER

Provider Business Mailing Address
First Line	:	2000 N FLORIDA MANGO RD STE 207
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6443
Country	:	US
Telephone Number	:	561-859-7552
Fax Number	:	561-450-5230

Provider Business Practice Location Address
First Line	:	676 PEPPERGRASS RUN
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-4233
Country	:	US
Telephone Number	:	561-859-7552
Fax Number	:	561-450-5230

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MRS. MONIQUE MARTIN
Credential	:
Telephone Number	:	561-727-6196

Provider Enumeration Date	:	06/18/2020
Last Update Date	:	09/08/2020

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