| The Wave Of Brooksville, Llc | |
|
7300 Grove Rd Brooksville FL 34613-6012 | |
| (352) 442-2643 | |
| Not Available |
| Full Name | The Wave Of Brooksville, Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 7300 Grove Rd, Brooksville, Florida |
| Authorized Official Name and Position | Andre Genao (EXECUTIVE DIRECTOR - COMPLIANCE) |
| Authorized Official Contact | 3524422643 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Wave Of Brooksville, Llc 2120 Range Rd Clearwater FL 33765-2125 Ph: (352) 442-2643 | The Wave Of Brooksville, Llc 7300 Grove Rd Brooksville FL 34613-6012 Ph: (352) 442-2643 |
| NPI Number | 1568050565 |
|---|---|
| Provider Enumeration Date | 01/05/2021 |
| Last Update Date | 01/05/2021 |
| Certification Date | 01/05/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568050565 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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