Provider Demographics
NPI: | 1760732887 |
---|---|
Name: | SOLACE BEHAVIORAL HEALTH, LLC |
Entity Type: | Organization |
Organization Name: | SOLACE BEHAVIORAL HEALTH, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT, CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | TANVEER |
Authorized Official - Middle Name: | A |
Authorized Official - Last Name: | CHAUDHRY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 352-678-5550 |
Mailing Address - Street 1: | 4800 ROWAN RD |
Mailing Address - Street 2: | |
Mailing Address - City: | NEW PORT RICHEY |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 34653-5609 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 727-483-5912 |
Mailing Address - Fax: | 727-376-3652 |
Practice Address - Street 1: | 17222 HOSPITAL BLVD STE 120 |
Practice Address - Street 2: | |
Practice Address - City: | BROOKSVILLE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 34601-8906 |
Practice Address - Country: | US |
Practice Address - Phone: | 352-678-5550 |
Practice Address - Fax: | 352-678-5551 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-09-17 |
Last Update Date: | 2023-10-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Multi-Specialty |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 163WP0808X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health | Group - Multi-Specialty |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 2084A0401X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine | Group - Multi-Specialty |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
No | 364SP0808X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | GW088A | Other | MEDICARE |
FL | 010023100 | Medicaid | |
FL | DU2657 | Other | MEDICARE RAIL ROAD |
NC | I186 | Other | MEDICARE - NORTH CAROLINA - PALMETTO GBA |