Healthcare Provider Details

I. General information

NPI: 1881058063
Provider Name (Legal Business Name): SOUTH BROWARD POST 8195 VETERANS OF FOREIGN WARS OF THE UNITED STATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4432 PEMBROKE RD.
WEST PARK FL
33021-8106
US

IV. Provider business mailing address

4432 PEMBROKE RD.
WEST PARK FL
33021-8106
US

V. Phone/Fax

Practice location:
  • Phone: 954-987-6089
  • Fax: 954-367-3783
Mailing address:
  • Phone: 954-987-6089
  • Fax: 954-367-3783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT N. WHITE
Title or Position: C.E.O.
Credential: MENTAL HEALTH COUNSE
Phone: 954-931-1301