Provider Demographics
NPI:1831968171
Name:PBG WELLNESS CENTER LLC
Entity type:Organization
Organization Name:PBG WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEOFF
Authorized Official - Middle Name:
Authorized Official - Last Name:SPILLIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-307-1801
Mailing Address - Street 1:770 CRESCENT CIR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-4771
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3450 NORTHLAKE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33403-1712
Practice Address - Country:US
Practice Address - Phone:561-307-1801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility