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General NPI Number Information
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NPI Number | 1346668811
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Entity Type | Organization
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Legal Business Name | SILVER IMPACT, INC
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Dates
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Enumeration Date | 04/02/2014
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Last Update Date | 04/02/2014
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Provider Practice Location Address
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Address Line | 7155 W OAKLAND PARK BLVD
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City | LAUDERHILL
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State | FL
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Zip | 33313-1038
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Country | US
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Telephone | 954-572-0444
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Fax | 954-572-0092
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Provider Business Mailing Address
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Address Line | 7155 W OAKLAND PARK BLVD
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City | LAUDERHILL
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State | FL
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Zip | 33313-1038
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Country | US
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Telephone | 954-572-0444
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Fax | 954-572-0092
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ILLENE GALE GREENBERG
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Credential | J.D.
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Telephone | 954-572-0444
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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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