Healthcare Provider Details

I. General information

NPI: 1366861569
Provider Name (Legal Business Name): 4KIDS OF SOUTH FLORIDA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2717 W CYPRESS CREEK RD
FT LAUDERDALE FL
33309
US

IV. Provider business mailing address

2717 W CYPRESS CREEK RD
FT LAUDERDALE FL
33309-1756
US

V. Phone/Fax

Practice location:
  • Phone: 954-979-7911
  • Fax:
Mailing address:
  • Phone: 954-979-7911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: EDVARDO ARCHER
Title or Position: DIRECTOR
Credential:
Phone: 561-707-6150