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General NPI Number Information
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NPI Number | 1740432806
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Entity Type | Organization
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Legal Business Name | BROOKWOOD FLORIDA - SOUTH, INC
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 10/21/2008
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Provider Practice Location Address
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Address Line | 253 ROSE ST
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City | N FORT MYERS
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State | FL
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Zip | 33903-3759
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Country | US
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Telephone | 239-652-0354
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Fax |
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Provider Business Mailing Address
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Address Line | 253 ROSE ST
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City | N FORT MYERS
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State | FL
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Zip | 33903-3759
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Country | US
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Telephone | 239-652-0354
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MRS. DEANETTE ELAINE MONJE
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Credential | MH7929
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Telephone | 727-822-4789
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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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