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General NPI Number Information
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NPI Number | 1073885042
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Entity Type | Organization
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Legal Business Name | MEMORIAL HEALTHCARE SYSTEM
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Dates
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Enumeration Date | 02/06/2012
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Last Update Date | 02/06/2012
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Provider Practice Location Address
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Address Line | 1750 E HALLANDALE BEACH BLVD
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4611
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Country | US
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Telephone | 754-204-2904
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Fax |
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Provider Business Mailing Address
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Address Line | 1750 E HALLANDALE BEACH BLVD
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4611
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Country | US
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Telephone | 754-204-2904
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Fax |
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Authorized Official
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Title or Position | HEALTHY FAMILIES TEAM LEADER
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Name | MRS. MARIA P DOMINGUEZ
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Credential | MGC-CAP
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Telephone | 754-204-2904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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