Healthcare Provider Details

I. General information

NPI: 1760375984
Provider Name (Legal Business Name): FOUR WALLS STUDIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6941 SW 196TH AVE UNIT 21-2
PEMBROKE PINES FL
33332
US

IV. Provider business mailing address

6941 SW 196TH AVE UNIT 21-2
PEMBROKE PINES FL
33332
US

V. Phone/Fax

Practice location:
  • Phone: 305-924-3497
  • Fax:
Mailing address:
  • Phone: 305-924-3497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROUDELINE CELESTIN
Title or Position: MGR
Credential:
Phone: 305-934-3497