Healthcare Provider Details

I. General information

NPI: 1487908331
Provider Name (Legal Business Name): HOPEWELL CENTRE FOR HEALTHY LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8910 MIRAMAR PKWY SUITE 207
MIRAMAR FL
33025-4100
US

IV. Provider business mailing address

8910 MIRAMAR PKWY SUITE 207
MIRAMAR FL
33025-4100
US

V. Phone/Fax

Practice location:
  • Phone: 954-391-9469
  • Fax: 954-391-9469
Mailing address:
  • Phone: 954-391-9469
  • Fax: 954-391-9469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberMH8058
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberCAP 4776
License Number StateFL

VIII. Authorized Official

Name: ELAINE MORRIS
Title or Position: DIRECTOR
Credential: LMHC,CAP,SAP
Phone: 954-391-9469