Provider Demographics
NPI:1699052449
Name:HARP PALM BEACH, LLC
Entity type:Organization
Organization Name:HARP PALM BEACH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GINO
Authorized Official - Middle Name:
Authorized Official - Last Name:CICERCHIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-512-2873
Mailing Address - Street 1:2655 NORTH OCEAN DRIVE, SUITE 103
Mailing Address - Street 2:
Mailing Address - City:SINGER ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33404
Mailing Address - Country:US
Mailing Address - Phone:561-594-0206
Mailing Address - Fax:561-594-0207
Practice Address - Street 1:2655 NORTH OCEAN DRIVE, SUITE 103
Practice Address - Street 2:
Practice Address - City:SINGER ISLAND
Practice Address - State:FL
Practice Address - Zip Code:33404
Practice Address - Country:US
Practice Address - Phone:561-594-0206
Practice Address - Fax:561-594-0207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-08
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility