The Wave of Brooksville, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

THE WAVE OF BROOKSVILLE, LLC

Practice address

7300 Grove Rd
Brooksville, FL 34613-6012

Phone

(352) 442-2643

NPI assigned

Jan 5, 2021

Organization subpart

No

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

Authorized official

Name

Andre Genao

Title

Executive Director - Compliance

Phone

(352) 442-2643

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1609804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609804800000",
    "number": "1568050565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2120 RANGE RD",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337652125",
            "telephone_number": "352-442-2643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7300 GROVE RD",
            "city": "BROOKSVILLE",
            "state": "FL",
            "postal_code": "346136012",
            "telephone_number": "352-442-2643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE WAVE OF BROOKSVILLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-05",
        "last_updated": "2021-01-05",
        "certification_date": "2021-01-05",
        "status": "A",
        "authorized_official_last_name": "GENAO",
        "authorized_official_first_name": "ANDRE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR - COMPLIANCE",
        "authorized_official_telephone_number": "352-442-2643"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Brooksville, FL
• Providers in Brooksville, FL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2021; 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.