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General NPI Number Information
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NPI Number | 1760375984
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Entity Type | Organization
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Legal Business Name | FOUR WALLS STUDIO LLC
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Dates
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Enumeration Date | 05/29/2025
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 6941 SW 196TH AVE UNIT 21-2
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City | PEMBROKE PINES
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State | FL
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Zip | 33332
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Country | US
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Telephone | 305-924-3497
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Fax |
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Provider Business Mailing Address
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Address Line | 6941 SW 196TH AVE UNIT 21-2
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City | PEMBROKE PINES
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State | FL
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Zip | 33332
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Country | US
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Telephone | 305-924-3497
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Fax |
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Authorized Official
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Title or Position | MGR
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Name | ROUDELINE CELESTIN
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Credential |
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Telephone | 305-934-3497
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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