Healthcare Provider Details

I. General information

NPI: 1386800241
Provider Name (Legal Business Name): GUIDANCE CLINIC OF THE MIDDLE KEYS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 41ST OCEAN
MARATHON FL
33050-2373
US

IV. Provider business mailing address

3000 41ST OCEAN
MARATHON FL
33050
US

V. Phone/Fax

Practice location:
  • Phone: 305-434-9000
  • Fax: 305-434-9041
Mailing address:
  • Phone: 305-434-9000
  • Fax: 305-434-9041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number StateFL

VIII. Authorized Official

Name: MS. PATTY POLIVCHAK
Title or Position: HUMAN RESOURCES
Credential:
Phone: 305-394-9033