Organization
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Organization subpart
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Provider details
NPI number
Authorized official
MRS. BRENDA DAVIS (ADMINISTRATOR)
(954) 987-2293
Entity
Organization
Contact information
Practice address
5120 SW 22ND ST, WEST PARK, FL 33023-3224
(954) 987-2293
(954) 964-5274
Mailing address
5120 SW 22ND ST, WEST PARK, FL 33023-3224
(954) 987-2293
(954) 964-5274
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
671558396
—
FL
05
—
671558398
—
FL
Enumeration date
05/30/2008
Last updated
05/30/2008
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