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General NPI Number Information
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NPI Number | 1306091913
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Entity Type | Organization
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Legal Business Name | HEALTHY FAMILIES BROWARD
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Dates
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Enumeration Date | 11/24/2008
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Last Update Date | 11/24/2008
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Provider Practice Location Address
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Address Line | 915 MIDDLE RIVER DR STE 120
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City | FT LAUDERDALE
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State | FL
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Zip | 33304-3559
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Country | US
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Telephone | 754-246-0422
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Fax | 954-563-6063
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Provider Business Mailing Address
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Address Line | 915 MIDDLE RIVER DRIVE SUITE # 120
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City | FT. LAUDERDALE
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State | FL
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Zip | 33304
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Country | US
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Telephone | 754-246-0422
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Fax | 954-563-6063
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Authorized Official
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Title or Position | FAMILY SUPPORT WORKER SUPERVISOR
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Name | MRS. MARTA CECILIA GUTIERREZ
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Credential |
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Telephone | 754-246-0422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | G362543639420
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License Number State | FL
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