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General NPI Number Information
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NPI Number | 1245801091
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Entity Type | Organization
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Legal Business Name | ACTIVE COMMUNITY HEALTH CENTER CORP
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Dates
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Enumeration Date | 07/02/2021
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Last Update Date | 07/19/2021
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Provider Practice Location Address
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Address Line | 6830 PINES BLVD
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-7545
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Country | US
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Telephone | 954-333-8787
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Fax | 954-333-8621
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Provider Business Mailing Address
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Address Line | 19321 SW 14TH ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-6124
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Country | US
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Telephone | 954-394-3095
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Fax | 954-333-8621
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Authorized Official
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Title or Position | CEO
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Name | PABLO URIARTE
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Credential | LCSW
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Telephone | 954-394-3095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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