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General NPI Number Information
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NPI Number | 1629795463
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Entity Type | Organization
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Legal Business Name | THE DIVINE MIND HEALTHCARE EDUCATIONAL ADVANCED LEARNING SITE
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Dates
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Enumeration Date | 10/24/2022
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Last Update Date | 10/24/2022
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Provider Practice Location Address
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Address Line | 11 PALM AVE
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-6430
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Country | US
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Telephone | 954-603-1896
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Fax | 954-678-2998
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Provider Business Mailing Address
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Address Line | 11 PALM AVE
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-6430
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Country | US
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Telephone | 954-603-1896
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Fax | 954-678-2998
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Authorized Official
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Title or Position | EDUCATOR
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Name | DENISE Y MELENDEZ
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Credential | MBA
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Telephone | 954-857-8479
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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