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General NPI Number Information
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NPI Number | 1710574108
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Entity Type | Organization
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Legal Business Name | MEMORIAL HEALTHCARE SYSTEM
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Dates
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Enumeration Date | 12/31/2020
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Last Update Date | 12/31/2020
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Provider Practice Location Address
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Address Line | 7031 TAFT ST
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City | HOLLYWOOD
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State | FL
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Zip | 33024-3864
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Country | US
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Telephone | 954-662-6107
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Fax |
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Provider Business Mailing Address
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Address Line | 7031 TAFT ST
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City | HOLLYWOOD
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State | FL
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Zip | 33024-3864
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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 | FAMILY PEER SPECIALIST
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Name | MRS. BRANDAISE MOZELL-HARVEY
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Credential | CRPS
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Telephone | 954-662-6107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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