MEDICARE: PUR HEALTH AND 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
2	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1922599885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUR HEALTH AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	1581 OLD DIXIE HWY
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-3654
Country	:	US
Telephone Number	:	772-971-9197
Fax Number	:

Provider Business Practice Location Address
First Line	:	1581 OLD DIXIE HIGHWAY
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960
Country	:	US
Telephone Number	:	772-971-9197
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KENNETH L COOPER
Credential	:
Telephone Number	:	772-999-8979

Provider Enumeration Date	:	05/25/2018
Last Update Date	:	04/09/2026

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Directions to “PUR HEALTH AND WELLNESS LLC ” Practice Location

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