Organization
PANACHE HOLISTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY E PROVENCHER (PRESIDENT, CEO)
(239) 839-4997
Entity
Organization
Contact information
Practice address
2552 BARCELONA AVE, FORT MYERS, FL 33905-2212
(239) 410-6250
Mailing address
2552 BARCELONA AVE, FORT MYERS, FL 33905-2212
(239) 410-6250
Taxonomy
Speciality
Code
Description
License number
State
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
Primary
—
—
Other
Enumeration date
01/31/2022
Last updated
01/31/2022
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