Organization
THE WAVE OF BROOKSVILLE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDRE GENAO (EXECUTIVE DIRECTOR - COMPLIANCE)
(352) 442-2643
Entity
Organization
Contact information
Practice address
7300 GROVE RD, BROOKSVILLE, FL 34613-6012
(352) 442-2643
Mailing address
2120 RANGE RD, CLEARWATER, FL 33765-2125
(352) 442-2643
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
01/05/2021
Last updated
01/05/2021
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