Healthcare Provider Details

I. General information

NPI: 1366378481
Provider Name (Legal Business Name): BOYS & GIRLS CLUBS OF BROWARD COUNTY HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7201 KIMBERLY BLVD
NORTH LAUDERDALE FL
33068-2336
US

IV. Provider business mailing address

7201 KIMBERLY BLVD
NORTH LAUDERDALE FL
33068-2336
US

V. Phone/Fax

Practice location:
  • Phone: 954-537-1010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MATT ORGAN
Title or Position: CEO
Credential:
Phone: 954-537-1010