| The Wave International Llc | |
|
2120 Range Rd Clearwater FL 33765-2125 | |
| (727) 205-7077 | |
| Not Available |
| Full Name | The Wave International Llc |
|---|---|
| Speciality | Psychiatric Residential Treatment Facility |
| Location | 2120 Range Rd, Clearwater, Florida |
| Authorized Official Name and Position | Christopher Wright Fox (CEO) |
| Authorized Official Contact | 3105477501 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Wave International Llc 28059 Us Highway 19 N Ste 205 Clearwater FL 33761-2620 Ph: (727) 205-2077 | The Wave International Llc 2120 Range Rd Clearwater FL 33765-2125 Ph: (727) 205-7077 |
| NPI Number | 1588130363 |
|---|---|
| Provider Enumeration Date | 10/18/2018 |
| Last Update Date | 10/01/2025 |
| Certification Date | 10/01/2025 |
| Medicare PECOS PAC ID | 9436563376 |
|---|---|
| Medicare Enrollment ID | O20221209002048 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588130363 | NPI | - | NPPES |
| Provider Name | Roberta Marie Mosher |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871223917 PECOS PAC ID: 6103281035 Enrollment ID: I20230428001634 |
| Provider Name | Brenda S Pinson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669921227 PECOS PAC ID: 4880034073 Enrollment ID: I20240506000614 |
| Provider Name | Cynthia Mlinar |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1932594074 PECOS PAC ID: 3678914710 Enrollment ID: I20240507003517 |
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