Healthcare Provider Details

I. General information

NPI: 1578013686
Provider Name (Legal Business Name): SOUTH FLORIDA WELLNESS CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 05/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 S HOSPITAL DR SUITE 102
PLANTATION FL
33317-2813
US

IV. Provider business mailing address

4100 S HOSPITAL DR SUITE 102
PLANTATION FL
33317-2813
US

V. Phone/Fax

Practice location:
  • Phone: 954-990-5922
  • Fax: 954-357-3624
Mailing address:
  • Phone: 954-990-5922
  • Fax: 954-357-3624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: ROBERT ANTOINE
Title or Position: CEO
Credential: MD
Phone: 954-300-6045