Healthcare Provider Details

I. General information

NPI: 1750860938
Provider Name (Legal Business Name): WHOLE FAMILY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

981 37TH PL
VERO BEACH FL
32960-6541
US

IV. Provider business mailing address

827 18TH ST
VERO BEACH FL
32960-6481
US

V. Phone/Fax

Practice location:
  • Phone: 772-257-5785
  • Fax: 772-257-5325
Mailing address:
  • Phone: 772-925-8190
  • Fax: 772-925-8199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MARIE ANDRESS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 772-925-8200