Provider Demographics
NPI:1548774763
Name:NOVUS MEDICAL DETOX CENTER OF WEST PALM BEACH,LLC
Entity Type:Organization
Organization Name:NOVUS MEDICAL DETOX CENTER OF WEST PALM BEACH,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
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:
Mailing Address - Fax:
Practice Address - Street 1:1101 54TH ST
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2419
Practice Address - Country:US
Practice Address - Phone:727-232-8356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility