Healthcare Provider Details

I. General information

NPI: 1144288432
Provider Name (Legal Business Name): FLORIDA COMMUNITY HEALTH CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5827 CORPORATE WAY
WEST PALM BEACH FL
33407-2000
US

IV. Provider business mailing address

5827 CORPORATE WAY
WEST PALM BEACH FL
33407-2000
US

V. Phone/Fax

Practice location:
  • Phone: 561-844-9443
  • Fax: 561-844-1013
Mailing address:
  • Phone: 561-844-9443
  • Fax: 561-844-1013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: WILHELMINA N. LEWIS
Title or Position: PRESIDENT & CEO
Credential:
Phone: 561-844-9443