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General NPI Number Information
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NPI Number | 1306501721
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Entity Type | Organization
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Legal Business Name | INTECELLE, INC.
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Dates
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Enumeration Date | 11/01/2021
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Last Update Date | 11/01/2021
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Provider Practice Location Address
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Address Line | 925 W WASHINGTON ST STE 200
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City | MONTICELLO
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State | FL
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Zip | 32344-1122
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Country | US
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Telephone | 954-756-9709
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Fax |
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Provider Business Mailing Address
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Address Line | 11110 W OAKLAND PARK BLVD STE 360
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City | SUNRISE
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State | FL
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Zip | 33351-6808
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | YVES CHARLES
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Credential |
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Telephone | 954-756-9709
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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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