Provider Demographics
NPI:1639539349
Name:SANCTUARY OF PALM BEACH COUNTY LLC
Entity Type:Organization
Organization Name:SANCTUARY OF PALM BEACH COUNTY LLC
Other - Org Name:SANCTUARY WELLNESS OF BOCA RATON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:561-279-5221
Mailing Address - Street 1:350 CAMINO GARDENS BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-5846
Mailing Address - Country:US
Mailing Address - Phone:855-345-3334
Mailing Address - Fax:
Practice Address - Street 1:350 CAMINO GARDENS BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-5846
Practice Address - Country:US
Practice Address - Phone:855-345-3334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-24
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation