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General NPI Number Information
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NPI Number | 1124373113
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Entity Type | Organization
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Legal Business Name | DISTRICT CLINIC HOLDINGS INC
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Dates
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Enumeration Date | 07/17/2012
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Last Update Date | 05/04/2021
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Provider Practice Location Address
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Address Line | 39200 HOOKER HWY STE 101
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City | BELLE GLADE
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State | FL
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Zip | 33430-5368
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Country | US
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Telephone | 561-642-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 1515 N FLAGLER DR STE 101
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-3429
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Country | US
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Telephone | 561-659-1270
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Fax | 561-833-9469
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Authorized Official
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Title or Position | CEO
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Name | DARCY DAVIS
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Credential |
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Telephone | 561-804-5885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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