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THE WAVE OF BROOKSVILLE LLC NPI 1568050565


NPI Information

NPI: 1568050565
Provider Name: THE WAVE OF BROOKSVILLE, LLC
Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

CLIA Number: 10D2225519

Address:
7300 GROVE RD
BROOKSVILLE, FL
ZIP 34613
Phone: (352) 442-2643
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THE WAVE OF BROOKSVILLE, LLC is a mental health (including community mental health center) clinic center in Brooksville, FL. THE WAVE OF BROOKSVILLE, LLC NPI is 1568050565. The provider is registered as an organization entity type.

The provider's business location address is:

7300 GROVE RD
BROOKSVILLE, FL
ZIP 34613-012
Phone: (352) 442-2643

The provider's authorized official is Andre Genao .
The authorized official title is Executive Director - Compliance and has the following contact phone number (352) 442-2643.

The CLIA number assigned to this NPI record is 10D2225519 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/5/2021 and was last updated on 1/5/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QM0801XClinic/CenterMental Health (Including Community Mental Health Center)Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.