Provider Demographics
NPI:1750754891
Name:BEACH HOUSE TREATMENT CENTER,LLC
Entity type:Organization
Organization Name:BEACH HOUSE TREATMENT CENTER,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:PUNDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-912-1267
Mailing Address - Street 1:13211 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:JUNO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-2799
Mailing Address - Country:US
Mailing Address - Phone:561-337-3200
Mailing Address - Fax:
Practice Address - Street 1:13321 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:JUNO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-2799
Practice Address - Country:US
Practice Address - Phone:561-799-1980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-12
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness