Provider Demographics
NPI:1225328370
Name:WELLINGTON RETREAT, INC
Entity Type:Organization
Organization Name:WELLINGTON RETREAT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, BILLING/CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:JAYNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BAZZANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-296-5288
Mailing Address - Street 1:7051 SEACREST BLVD
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-5139
Mailing Address - Country:US
Mailing Address - Phone:561-296-5288
Mailing Address - Fax:561-296-5287
Practice Address - Street 1:7051 SEACREST BLVD
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-5139
Practice Address - Country:US
Practice Address - Phone:561-296-5288
Practice Address - Fax:561-623-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility