Provider Demographics
NPI:1477896991
Name:NOVUS MEDICAL DETOX CENTER
Entity Type:Organization
Organization Name:NOVUS MEDICAL DETOX CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WESCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-232-8356
Mailing Address - Street 1:9270 ROYAL PALM AVE
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-5018
Mailing Address - Country:US
Mailing Address - Phone:727-232-8356
Mailing Address - Fax:727-232-8408
Practice Address - Street 1:9270 ROYAL PALM AVE
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-5018
Practice Address - Country:US
Practice Address - Phone:727-232-8356
Practice Address - Fax:727-232-8408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSR51AD2352-01324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0652AD235201OtherPA GROUP