Sanctuary Clinic of Yahweh, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

SANCTUARY CLINIC OF YAHWEH, LLC

Practice address

15 S Verona Ave
Avon Park, FL 33825-3913

Phone

(863) 453-3174

NPI assigned

Dec 9, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Benito Edouard, MD

Title

President

Phone

(863) 273-1097

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1607472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607472000000",
    "number": "1821694282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 S VERONA AVE",
            "city": "AVON PARK",
            "state": "FL",
            "postal_code": "338253913",
            "telephone_number": "863-453-3174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 S VERONA AVE",
            "city": "AVON PARK",
            "state": "FL",
            "postal_code": "338253913",
            "telephone_number": "863-453-3174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANCTUARY CLINIC OF YAHWEH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-09",
        "last_updated": "2020-12-09",
        "certification_date": "2020-12-09",
        "status": "A",
        "authorized_official_last_name": "EDOUARD",
        "authorized_official_first_name": "BENITO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "863-273-1097",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Avon Park, FL
• Providers in Avon Park, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 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.