EBB TIDE TREATMENT LLC NPI 1699135186

NPI Information

  • NPI: 1699135186
  • Provider Name: EBB TIDE TREATMENT LLC
  • Classification: Clinic/Center - 261QM0850X
  • Specialization: Adult Mental Health
  • Entity Type: Organization
  • Doing Business As: EBB TIDE TREATMENT CENTERS
  • CLIA Number: 10D2110099
  • Address: 400 EXECUTIVE CENTER DR STE 209
    WEST PALM BEACH, FL
    ZIP 33401
  • Phone: (561) 508-8330

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NPI Details

EBB TIDE TREATMENT LLC is an adult mental health clinic center in West Palm Beach, FL. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. EBB TIDE TREATMENT LLC NPI is 1699135186. The provider is registered as an organization entity type.
The provider Is Doing Business As Ebb Tide Treatment Centers.

The provider's business location address is:

400 EXECUTIVE CENTER DR STE 209
WEST PALM BEACH, FL
ZIP 33401-922
Phone: (561) 508-8330

The provider's authorized official is Joseph Kilkenny Donovan .
The authorized official title is Ceo and has the following contact phone number (561) 508-8330.

The CLIA number assigned to this NPI record is 10D2110099 - comp. outpatient rehab facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/26/2016 and was last updated on 12/7/2023.

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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QR0405XClinic/CenterRehabilitation, Substance Use DisorderFLORIDANo
2324500000XSubstance Abuse Rehabilitation FacilityNo
3261QM0850XClinic/CenterAdult Mental HealthYes

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: 11/21/2025

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