| NPI | 1609583673 |
|---|---|
| Doing Business As | THE WAVE OF EDGEWATER |
| Entity Type | Organization |
| Authorized Contact | ANDRE GENAO Chief Compliance Officer 352-442-2643 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2022-10-31 |
| Last Update Date | 2022-10-31 |