EBB TIDE TREATMENT LLC (NPI# 1750828943) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750828943 |
| Entity Type | Organization |
| Organization Name | EBB TIDE TREATMENT LLC |
| Practice Address |
3385 Burns Rd Suite 108 Palm Beach Gardens FL 33410-4328 |
| Practice Telephone | 5615088330 |
| Practice Fax Number | 5615908331 |
| Mailing Fax Number | 5615088331 |
| Enumeration Date | 2017-01-25 |
| Last Update Date | 2017-01-25 |
| Authorized Official Name | MR. JOSEPH KILKENNY DONOVAN (CEO) |
| Authorized Official Telephone | 5168842631 |
| Authorized Official Credential | J.D. |
| Is Organization Subpart | Y |
| Parent Organization Name | EBB TIDE TREATMENT LLC |
| Parent Organization TIN |
|
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QA0401X |
Family Medicine Specialization: Addiction Medicine |
50=========01 | FL | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699135186 | Ebb Tide Treatment LLC | Clinic/Center | 3385 Burns Rd, Suite 108, Palm Beach Gardens, FL 33410-4328 | 2016-02-26 |
| Street Address |
3385 BURNS RD SUITE 108 |
| City | PALM BEACH GARDENS |
| State | FL |
| Zip Code | 33410-4328 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083606750 | Michael Ralph Grimmett | Ophthalmology | 3385 Burns Rd, Suite 209, Palm Beach Gardens, FL 33410-4328 | 2005-08-18 |
| 1821588229 | Kathleen Robinson | Family Medicine | 3385 Burns Rd, Palm Beach Gardens, FL 33410-4328 | 2018-05-11 |
| 1538611595 | Velvet Chong | Registered Nurse | 3385 Burns Rd, Palm Beach Gardens, FL 33410-4328 | 2016-10-25 |
| 1245694025 | Health Associates of Palm Beach | Clinic/Center | 3385 Burns Rd, Suite 208, Palm Beach Gardens, FL 33410-4328 | 2016-04-07 |
| 1699135186 | Ebb Tide Treatment LLC | Clinic/Center | 3385 Burns Rd, Suite 108, Palm Beach Gardens, FL 33410-4328 | 2016-02-26 |
| 1952776544 | Palm Beach Elite Counseling Services, LLC | Psychiatry & Neurology | 3385 Burns Rd, Suite 200, Palm Beach Gardens, FL 33410-4328 | 2015-12-08 |
| 1750774246 | Wellness and Hormone Centers of America Palm Beach County II, LLC | Clinic/Center | 3385 Burns Rd, Suite 101, Palm Beach Gardens, FL 33410-4328 | 2015-03-09 |
| 1164839338 | Palm Beach Elite, Inc | Substance Abuse Rehabilitation Facility | 3385 Burns Rd, Suite 200, Palm Beach Gardens, FL 33410-4328 | 2014-07-18 |
| 1790113363 | Independent Imaging, LLC | Clinic/Center | 3385 Burns Rd, Suite 109, Palm Beach Gardens, FL 33410-4328 | 2013-10-17 |
| 1093141319 | Elaine Marie Carr | Dentist | 3385 Burns Rd, 104, Palm Beach Gardens, FL 33410-4328 | 2013-09-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811501026 | Vicky Pauline Salazar | Registered Nurse | 11501 N Military Trail, Palm Beach Gardens, FL 33410 | 2020-09-04 |
| 1417596388 | Chavon E Mayer | Doula | 149 Winter Park Lane, West Palm Beach, FL 33410 | 2019-12-24 |
| 1639711617 | Diamond Physical Therapy, LLC | Physical Therapist | 4025 Johnson Dairy Road, Palm Beach Gardens, FL 33410 | 2019-10-11 |
| 1689151714 | Caroline Devries Hesterman | Occupational Therapist | 9840 Alternate A1a Ste 402, Palm Beach Gardens, FL 33410 | 2018-07-21 |
| 1366937088 | Krystal Maya Khemkaran | Behavior Technician | 2979 Pga Blvd # 200, Palm Beach Gardens, FL 33410 | 2018-06-25 |
| 1548762552 | Arsenia Pomperada Sabusap | Nurse Practitioner | Grace Medical Center of Florida, 4212 Northlake Blvd., Palm Beach Gardens, FL 33410 | 2018-03-06 |
| 1538668199 | Alan Seidenfeld | Dentist | 7305 N Military Trl 3a-200, Riviera Beach, FL 33410 | 2018-02-08 |
| 1407361454 | Nuvista Living At Jupiter, LLC | Skilled Nursing Facility | 338 Pioneer Road, Jupiter, FL 33410 | 2017-12-12 |
| 1083125728 | Tom Long Biddle-xing | Nurse Practitioner | 3345 Burns Rd Ste 206, Palm Beach Gardens, FL 33410 | 2017-10-20 |
| 1801315189 | Kasie Sidman | Physical Therapist | 3929 Bluebell St, Palm Beach Gardens, FL 33410 | 2017-09-18 |
| Find all providers in zip 33410 | ||||
| Taxonomy Code | 207QA0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Addiction Medicine |
| A family medicine physician who specializes in the diagnosis and treatment of addictions. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) was, but is no longer issued by the American Osteopathic Board of Family Physicians. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003365800 | Family First | Family Medicine | 5220 Hood Road, Suite 100, Palm Beach Gardens, FL 33418-8910 | 2016-09-22 |
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| 1649895095 | Bdmj Holdings | Family Medicine | 2150 Lake Ida Rd Ste 2, Delray Beach, FL 33445-2443 | 2020-06-11 |
| 1932730942 | Freeport Medical Associates | Family Medicine | 17256 Main St N Ste 1, Blountstown, FL 32424-1775 | 2020-01-29 |
| 1649822867 | Medical Partners of The Palm Beaches | Family Medicine | 2600 Quantum Blvd Bldg A, Boynton Beach, FL 33426-8627 | 2019-07-09 |
| 1780247064 | Pinnacle Rehabilitation Group | Family Medicine | 1680 Se Lyngate Dr Ste 204, Port Saint Lucie, FL 34952-4300 | 2019-04-22 |
| 1518441252 | Solstice Health and Wellness, LLC | Family Medicine | 1219 S East Ave South, Suite C204, Sarasota, FL 34239-2340 | 2018-09-19 |
| 1063956761 | Inspirations Recovery Center, LLC | Family Medicine | 5208 10th Ave N, Greenacres, FL 33463-2053 | 2016-12-14 |
| 1396290409 | Aquarius Physicians Group | Family Medicine | 749 Us Highway 1, Suite 210, North Palm Beach, FL 33408-4400 | 2016-08-18 |
| 1861823452 | Parthenon Behavioral Center | Family Medicine | 5101 Bowden Road, Jacksonville, FL 32216 | 2013-12-06 |
| 1457697278 | South Walton Medical Group | Family Medicine | 10065 Us Highway 98 W Ste B101, Miramar Beach, FL 32550-1902 | 2012-12-26 |
| 1851682066 | Jn Medical LLC | Family Medicine | 2625 West Way, Singer Island, FL 33404-3833 | 2011-04-21 |
| Find all providers with the same taxonomy | ||||
| City | PALM BEACH GARDENS |
| Zip Code | 33410 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.