Provider Demographics
NPI:1730431222
Name:HOLISTIX BY THE SEA
Entity type:Organization
Organization Name:HOLISTIX BY THE SEA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:COCCIA
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:856-889-0617
Mailing Address - Street 1:6261 W ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5128
Mailing Address - Country:US
Mailing Address - Phone:856-889-0617
Mailing Address - Fax:856-889-0617
Practice Address - Street 1:6261 W ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5128
Practice Address - Country:US
Practice Address - Phone:856-889-0617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-08
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility