Organization
SOHO WELLNESS INITIATIVE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLA RAJARAM (BILLING MANAGER)
(954) 272-6723
Entity
Organization
Contact information
Practice address
4801 S CONGRESS AVE, SUITE 120, LAKE WORTH, FL 33461-4746
(561) 214-7614
Mailing address
4801 S CONGRESS AVE, SUITE 120, LAKE WORTH, FL 33461-4746
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
FL
Other
Enumeration date
05/31/2016
Last updated
05/31/2016
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