Healthcare Provider Details

I. General information

NPI: 1164839841
Provider Name (Legal Business Name): DISTRICT CLINIC HOLDINGS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 SHILOH DR
WEST PALM BEACH FL
33407
US

IV. Provider business mailing address

1515 N FLAGLER DR STE 101
WEST PALM BEACH FL
33401-3429
US

V. Phone/Fax

Practice location:
  • Phone: 561-242-5445
  • Fax: 561-242-5447
Mailing address:
  • Phone: 561-659-1270
  • Fax: 561-833-9469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DARCY J DAVIS
Title or Position: CEO
Credential:
Phone: 561-804-5885