Healthcare Provider Details

I. General information

NPI: 1255391348
Provider Name (Legal Business Name): SPIRIT HEALTH AND EMPOWERMENT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2331 N STATE ROAD 7 SUITE 124
LAUDERHILL FL
33313
US

IV. Provider business mailing address

2331 N STATE ROAD 7 SUITE 124
LAUDERDALE LAKES FL
33313-3748
US

V. Phone/Fax

Practice location:
  • Phone: 954-484-6898
  • Fax:
Mailing address:
  • Phone: 954-484-6898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License NumberMW122
License Number StateFL

VIII. Authorized Official

Name: MRS. WYLENE BERNADETTE SIMMONS-ELLINGTON
Title or Position: PRESIDENT
Credential: LM
Phone: 954-484-6898