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General NPI Number Information
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NPI Number | 1013663525
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Entity Type | Individual
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Provider Name | CONSTANCE ROYAL HARRIS-CALLOWAY PROVIDER
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Gender | Female
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Dates
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Enumeration Date | 02/23/2022
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Last Update Date | 02/23/2022
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Provider Practice Location Address
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Address Line | 3800 INVERRARY BLVD
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City | LAUDERHILL
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State | FL
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Zip | 33319-4382
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Country | US
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Telephone | 954-445-8412
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Fax | 754-701-0328
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Provider Business Mailing Address
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Address Line | 2060 NW 28TH TER
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City | FT LAUDERDALE
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State | FL
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Zip | 33311-3334
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Country | US
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Telephone | 195-491-4203
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State | FL
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