| NPI |
1235162744 |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
| Entity Type Code |
2 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
| Employer Identification Number EIN |
|
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
| Provider Organization Name Legal Business Name |
CENTER FOR FAMILY HEALTH & WELLNESS INC |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
| Provider First Line Business Practice Location Address |
5900 HIATUS RD |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
| Provider Second Line Business Practice Location Address |
SUITE 100 |
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot
include a Post Office box. |
| Provider Business Practice Location Address City Name |
COPPER CITY |
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot
include a Post Office box. |
| Provider Business Practice Location Address State Name |
FL |
The State code in the location of the provider
being identified. |
| Provider Business Practice Location Address Postal Code |
33330 |
The State code in the location of the provider
being identified. |
| Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
| Provider Business Practice Location Address Telephone Number |
9542527744 |
The country code in the location address of the provider being identified. |
| Provider Business Practice Location Address Fax Number |
9542527556 |
The fax number associated with the location
address of the provider being identified. |
| Provider Enumeration Date |
7/8/2006 |
The fax number associated with the location
address of the provider being identified. |
| Last Update Date |
5/11/2009 |
The date that a record was last updated or changed. |
| Authorized Official Last Name |
FERNANDEZ |
The date that a record was last updated or changed. |
| Authorized Official First Name |
ERIKA |
The first name of the authorized official. |
| Authorized Official Title or Position |
OFFICE COORDINATOR |
The first name of the authorized official. |
| Authorized Official Telephone Number |
9542527744 |
The 10-position telephone number of the authorized official. |
| Healthcare Provider Taxonomy Code 1 |
208D00000X |
The 10-position telephone number of the authorized official. |
| Healthcare Provider Primary Taxonomy Switch 1 |
N |
|
| Healthcare Provider Taxonomy Code 2 |
225100000X |
|
| Healthcare Provider Primary Taxonomy Switch 2 |
N |
|
| Healthcare Provider Taxonomy Code 3 |
111N00000X |
|
| Healthcare Provider Primary Taxonomy Switch 3 |
Y |
|
| Is Organization Subpart |
N |
|
| Authorized Official Name Prefix Text |
MISS |
|
| Healthcare Provider Taxonomy Group 1 |
193200000X MULTI-SPECIALTY GROUP |
|
| Healthcare Provider Taxonomy Group 2 |
193200000X MULTI-SPECIALTY GROUP |
|
| Healthcare Provider Taxonomy Group 3 |
193200000X MULTI-SPECIALTY GROUP |
|