Provider Demographics
NPI:1982268058
Name:M.A.T. OF THE PALM BEACHES LLC
Entity Type:Organization
Organization Name:M.A.T. OF THE PALM BEACHES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-779-6619
Mailing Address - Street 1:321 NORTHLAKE BLVD STE 116
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-5410
Mailing Address - Country:US
Mailing Address - Phone:561-779-6619
Mailing Address - Fax:
Practice Address - Street 1:321 NORTHLAKE BLVD STE 116
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-5410
Practice Address - Country:US
Practice Address - Phone:561-779-6619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder