| NPI | 1083109458 |
|---|---|
| Former Legal Business Name | JUPITER TAJ INVESTMENT GROUP, LLC |
| Doing Business As | WAVE MEDICAL ASSISTED THERAPY & COUNSELING |
| Entity Type | Organization |
| Authorized Contact | NICHOLAS BRADLEY BERKOS Chief Operating Officer 561-281-2105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2018-06-27 |