Healthcare Provider Details

I. General information

NPI: 1245416577
Provider Name (Legal Business Name): CENTER FOR GLOBAL HEALTH & HUMANITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 SW GLORIA LN
PORT ST LUCIE FL
34953-1554
US

IV. Provider business mailing address

1721 SW GLORIA LN
PORT ST LUCIE FL
34953-1554
US

V. Phone/Fax

Practice location:
  • Phone: 772-446-0389
  • Fax:
Mailing address:
  • Phone: 772-446-0389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberN05000007078
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberN05000007078
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberN05000007078
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberN05000007078
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberN05000007078
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberN05000007078
License Number StateFL

VIII. Authorized Official

Name: MR. DANIEL MICHAEL UKPONG
Title or Position: PRESIDENT
Credential: MPH
Phone: 772-446-0389