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2809 Poinsettia Ave Ste 1,2&6 West Palm Beach FL 33407-5426 | |
| (561) 469-9934 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 2809 Poinsettia Ave Ste 1,2&6, West Palm Beach, Florida |
| Authorized Official Name and Position | Keren Marie Roesser (MANAGING MEMBER) |
| Authorized Official Contact | 5613988336 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2809 Poinsettia Ave Ste 12&6 West Palm Beach FL 33407-5426 Ph: (561) 469-9934 | 2809 Poinsettia Ave Ste 1,2&6 West Palm Beach FL 33407-5426 Ph: (561) 469-9934 |
| NPI Number | 1104344225 |
|---|---|
| Provider Enumeration Date | 09/08/2017 |
| Last Update Date | 07/15/2024 |
| Certification Date | 07/15/2024 |
| Medicare PECOS PAC ID | 0143631440 |
|---|---|
| Medicare Enrollment ID | O20201117002232 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104344225 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | 11045 (Florida) | Secondary |
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