MEDICARE: OCEAN SKY WELLNESS, 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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	0601	FL

General Provider Information

NPI Number	:	1801336813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEAN SKY WELLNESS, LLC

Provider Business Mailing Address
First Line	:	4001 N OCEAN DR
Second Line	:	305
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-5968
Country	:	US
Telephone Number	:	844-468-1345
Fax Number	:	954-368-7645

Provider Business Practice Location Address
First Line	:	4001 N OCEAN DR
Second Line	:	101-102
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-5968
Country	:	US
Telephone Number	:	844-468-1345
Fax Number	:	954-368-7645

Authorized Official
Title or Position	:	DIRECTOR OF BILLING
Name	:	VERONICA HERNANDEZ
Credential	:
Telephone Number	:	954-203-3584

Provider Enumeration Date	:	02/24/2017
Last Update Date	:	07/21/2022

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