MEDICARE: RESOLVE WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1093327017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESOLVE WELLNESS

Provider Business Mailing Address
First Line	:	3000 NW 101ST LN
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-3930
Country	:	US
Telephone Number	:	954-272-4073
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 NW 101ST LN
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-3930
Country	:	US
Telephone Number	:	954-272-4073
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KIM M CHIDDO
Credential	:	MBA, MSHRM
Telephone Number	:	954-272-4073

Provider Enumeration Date	:	08/20/2020
Last Update Date	:	08/20/2020

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Directions to “RESOLVE WELLNESS ” Practice Location

Language	Start Address	Practice Location

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