Healthcare Provider Details

I. General information

NPI: 1194348052
Provider Name (Legal Business Name): OPEN FOOD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

476 SE 14TH ST
DANIA BEACH FL
33004-5335
US

IV. Provider business mailing address

476 SE 14TH ST
DANIA BEACH FL
33004-5335
US

V. Phone/Fax

Practice location:
  • Phone: 954-289-2811
  • Fax:
Mailing address:
  • Phone: 954-289-2811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. IAN SHARP
Title or Position: PRESIDENT
Credential: PHD
Phone: 954-289-2811