Healthcare Provider Details

I. General information

NPI: 1609307420
Provider Name (Legal Business Name): METAMORPHASIS CARE AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E BROWARD BLVD
FT LAUDERDALE FL
33301-3503
US

IV. Provider business mailing address

110 E BROWARD BLVD
FT LAUDERDALE FL
33301-3503
US

V. Phone/Fax

Practice location:
  • Phone: 954-609-7614
  • Fax:
Mailing address:
  • Phone: 954-609-7614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: THERESA SANTANA
Title or Position: ADMINISTRATOR
Credential:
Phone: 954-609-7614