Health Coach Direct Primary Care Practice PLLC

Primary specialty

Community Health Clinic/CenterTaxonomy code 261QC1500X

Legal business name

HEALTH COACH DIRECT PRIMARY CARE PRACTICE PLLC

Practice address

12300 Alternate A1A Ste 106
Palm Beach Gardens, FL 33410-2206

Phone

(561) 723-6019

NPI assigned

Sep 21, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Richard Charles, DO

Title

Medical Director

Phone

(561) 818-4151

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600646400000",
    "number": "1467068817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12300 ALTERNATE A1A STE 106",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334102206",
            "telephone_number": "561-723-6019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12300 ALTERNATE A1A STE 106",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334102206",
            "telephone_number": "561-723-6019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH COACH DIRECT PRIMARY CARE PRACTICE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-21",
        "last_updated": "2020-09-21",
        "certification_date": "2020-09-21",
        "status": "A",
        "authorized_official_last_name": "CHARLES",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "561-818-4151",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Lynn Havenstein, CRNA, MS
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• Healthy You LLC
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• Community Health Clinic/Center in Palm Beach Gardens, FL
• Providers in Palm Beach Gardens, FL by specialty
• Community Health Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.