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Provider Information for 1275078560

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Organization Subpart: NO

Organization NPI: 1275078560

Calendar   Last Updated:  2021-08-03
  Certification Date:  2021-08-03


Name Value
NPI 1275078560
Enumeration Date 2016-12-22
NPI Type 2- Organization
Status Active
Authorized Official Information Name: MR. JESSE REUTER
Title: OWNER
Phone: 561-818-9901
Mailing Address 455 NE 5TH AVE STE D306
DELRAY BEACH, FL 33483-5658
United States

Phone: 561-405-9062 | Fax:
View Map External Link
Primary Practice Address 900 54TH ST
WEST PALM BEACH, FL 33407-2436
United States

Phone: 561-818-9901 | Fax:
View Map External Link
Secondary Practice Address 7700 WEST CAMINO REAL 404
BOCA RATON, FL 33433-5543
United States

Phone: 561-818-9901 | Fax:
View Map External Link

Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 324500000X - Substance Abuse Rehabilitation Facility FL 50=========01