# LIFESTYLE WELLNESS CENTER OF THE PALM BEACHES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104071943
- **Authorized official:** MS. SANDY M WALDRON (BILLING ADMIN.)
- **Authorized official phone:** (772) 221-0190

## Contact information

- **Practice address:** 11903 SOUTHERN BLVD STE 110, ROYAL PALM BEACH, FL 33411-7644
- **Practice address phone:** (561) 386-2213
- **Mailing address:** 11903 SOUTHERN BLVD, SUITE 110, ROYAL PALM BEACH, FL 33411
- **Mailing address phone:** (561) 386-2213

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QH0100X | Health Service Clinic/Center | — | NULL | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/20/2008
- **Last updated:** 11/20/2008