Provider Demographics
NPI:1316250764
Name:PATRIOT HEALTH AND WELLNESS
Entity type:Organization
Organization Name:PATRIOT HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARASH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSSAFA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-237-1313
Mailing Address - Street 1:1701 SE HILLMOOR DR
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7552
Mailing Address - Country:US
Mailing Address - Phone:772-237-1313
Mailing Address - Fax:877-637-7509
Practice Address - Street 1:1701 SE HILLMOOR DR
Practice Address - Street 2:SUITE A-1
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7552
Practice Address - Country:US
Practice Address - Phone:772-237-1313
Practice Address - Fax:877-637-7509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities