Provider Demographics
NPI:1588051403
Name:PREMIER HEALTH AND WELLNESS CENTER OF THE PALM BEACHES, LLC
Entity type:Organization
Organization Name:PREMIER HEALTH AND WELLNESS CENTER OF THE PALM BEACHES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:YETZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-427-1770
Mailing Address - Street 1:221 GREENWICH CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2890
Mailing Address - Country:US
Mailing Address - Phone:561-427-1770
Mailing Address - Fax:
Practice Address - Street 1:221 GREENWICH CIR STE 100
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2891
Practice Address - Country:US
Practice Address - Phone:561-427-1770
Practice Address - Fax:800-349-5613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL614582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty