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General NPI Number Information
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NPI Number | 1508415332
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Entity Type | Organization
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Legal Business Name | EXULTATION COMMUNITY RESOURCE CENTER
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Dates
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Enumeration Date | 09/04/2019
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Last Update Date | 09/04/2019
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Provider Practice Location Address
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Address Line | 4000 N STATE ROAD 7 STE 401-2
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33319-4804
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Country | US
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Telephone | 954-478-5835
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Fax |
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Provider Business Mailing Address
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Address Line | 517 NW 16TH AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33311-8851
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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 | CEO
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Name | PHYLLIS MATHIS
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Credential |
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Telephone | 954-478-5835
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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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