Provider Demographics
NPI:1396532560
Name:FLORIDA SHORES WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:FLORIDA SHORES WELLNESS CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:POTERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-695-6847
Mailing Address - Street 1:2100 PARK CENTRAL BLVD N STE B
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-2239
Mailing Address - Country:US
Mailing Address - Phone:561-715-0548
Mailing Address - Fax:520-783-2467
Practice Address - Street 1:2100 PARK CENTRAL BLVD N STE B
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-2239
Practice Address - Country:US
Practice Address - Phone:561-715-0548
Practice Address - Fax:520-783-2467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-22
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder