Basic Information
| Provider Information | |||||||||
| NPI: | 1053972182 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOLACE HEALTH AND WELLNESS CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4800 ROWAN RD | ||||||||
| Address2: | |||||||||
| City: | NEW PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346535609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274835912 | ||||||||
| FaxNumber: | 7273763652 | ||||||||
| Practice Location | |||||||||
| Address1: | 8449 COBB RD | ||||||||
| Address2: | |||||||||
| City: | BROOKSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346018704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523292400 | ||||||||
| FaxNumber: | 3523292401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2019 | ||||||||
| LastUpdateDate: | 10/15/2021 | ||||||||
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| AuthorizedOfficialLastName: | SPADAFORA | ||||||||
| AuthorizedOfficialFirstName: | AMANDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3526785550 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 261QM1300X | N | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 251S00000X | N | Agencies | Community/Behavioral Health | 261QR0405X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.