Seaside Wellness of Palm Beach LLC

Primary specialty

Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X

Legal business name

SEASIDE WELLNESS OF PALM BEACH LLC

Practice address

106 Blossom LN
Palm Beach Shores, FL 33404-5705

Phone

(888) 831-4855

Fax

(949) 606-0488

NPI assigned

Feb 28, 2025

Last updated

Mar 3, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Nicholas Petrillo

Title

Ceo, Owner

Phone

(978) 440-3200

Specialties & licenses 4

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1740700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740960000000",
    "number": "1992502660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 NW 53RD ST STE 370",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334878241",
            "telephone_number": "978-788-4460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 BLOSSOM LN",
            "city": "PALM BEACH SHORES",
            "state": "FL",
            "postal_code": "334045705",
            "telephone_number": "888-831-4855",
            "fax_number": "949-606-0488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEASIDE WELLNESS OF PALM BEACH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-28",
        "last_updated": "2025-03-03",
        "certification_date": "2025-03-03",
        "status": "A",
        "authorized_official_last_name": "PETRILLO",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_title_or_position": "CEO, OWNER",
        "authorized_official_telephone_number": "978-440-3200",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eric Jeremy Holmgren, LMT
• Jessica Anne Hoyos, FNP-C
• Jodi Renee Julien
• Kimberly Kiernan, PHARMD
• Cara Louise McAllister, M.A. CCC-SLP

• Psychiatric Residential Treatment Facility in Palm Beach Shores, FL
• Providers in Palm Beach Shores, FL by specialty
• Psychiatric Residential Treatment Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.