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General NPI Number Information
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NPI Number | 1356058762
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Entity Type | Organization
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Legal Business Name | SPIRITUAL CONNECTION OUTREACH COMMUNITY CENTER OF SOUTH FLORIDA
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Dates
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Enumeration Date | 11/04/2022
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Last Update Date | 07/17/2024
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Provider Practice Location Address
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Address Line | 5975 W SUNRISE BVLD SUITE 210
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City | PLANTATION
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State | FL
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Zip | 33313-1663
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Country | US
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Telephone | 917-567-0530
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Fax |
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Provider Business Mailing Address
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Address Line | 5975 W SUNRISE BVLD
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City | PLANTATION
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State | FL
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Zip | 33313
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Country | US
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Telephone | 917-794-5972
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | JOANN RAIOLA
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Credential | CBHCMS
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Telephone | 917-567-0530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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