Provider Demographics
NPI:1629793393
Name:INTREPID HOLISTIC HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:INTREPID HOLISTIC HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:NASH
Authorized Official - Last Name:PAKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-782-6663
Mailing Address - Street 1:1926 10TH AVE N STE 420
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-3369
Mailing Address - Country:US
Mailing Address - Phone:516-512-2481
Mailing Address - Fax:
Practice Address - Street 1:318 S DIXIE HWY STE 4
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-4452
Practice Address - Country:US
Practice Address - Phone:561-782-6663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility