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General NPI Number Information
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NPI Number | 1891565149
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Entity Type | Organization
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Legal Business Name | COOK COMMUNITY HEALTH AGENCY INC
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Dates
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Enumeration Date | 01/08/2024
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Last Update Date | 01/08/2024
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Provider Practice Location Address
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Address Line | 528 N DIXIE HWY
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City | HOLLYWOOD
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State | FL
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Zip | 33020-4404
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Country | US
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Telephone | 954-461-4611
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Fax |
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Provider Business Mailing Address
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Address Line | 528 N DIXIE HWY
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City | HOLLYWOOD
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State | FL
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Zip | 33020-4404
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Country | US
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Telephone | 954-461-4611
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GLENN MARK CARTER II II
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Credential |
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Telephone | 954-461-4611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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