Healthcare Provider Details

I. General information

NPI: 1619925922
Provider Name (Legal Business Name): CRAWFORD CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3521 W BROWARD BLVD THIRD FLOOR
FT LAUDERDALE FL
33312-1048
US

IV. Provider business mailing address

3521 W BROWARD BLVD THIRD FLOOR
FT LAUDERDALE FL
33312-1048
US

V. Phone/Fax

Practice location:
  • Phone: 954-587-1008
  • Fax:
Mailing address:
  • Phone: 954-587-1008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License NumberN95000004564
License Number StateFL

VIII. Authorized Official

Name: MR. EDUARDO R. LACASA
Title or Position: C.O.O/GENERAL COUNSEL
Credential: JD
Phone: 954-587-1008