Healthcare Provider Details

I. General information

NPI: 1467005538
Provider Name (Legal Business Name): SOCIAL WELLNESS ADVOCACY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 NE 95TH ST
MIAMI SHORES FL
33138-2706
US

IV. Provider business mailing address

890 NW 213TH TER APT 203
MIAMI GARDENS FL
33169-2181
US

V. Phone/Fax

Practice location:
  • Phone: 786-707-5713
  • Fax:
Mailing address:
  • Phone: 786-707-5713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: TEKISHA DURAND
Title or Position: CEO/DIRECTOR
Credential: RCSWI
Phone: 786-707-5713