Provider Demographics
NPI:1942697503
Name:WELLNESS CENTER OF PALM BEACH HEALTH
Entity Type:Organization
Organization Name:WELLNESS CENTER OF PALM BEACH HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAYEESH
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-557-9298
Mailing Address - Street 1:2724 N AUSTRALIAN AVE BLDG 1
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-4501
Mailing Address - Country:US
Mailing Address - Phone:561-557-9298
Mailing Address - Fax:888-570-6904
Practice Address - Street 1:2724 N AUSTRALIAN AVE BLDG 1
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-4501
Practice Address - Country:US
Practice Address - Phone:561-557-9298
Practice Address - Fax:888-570-6904
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLNESS CENTER OF PALM BEACH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service