| NPI | 1437768116 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANISHA HODGE Administrator 954-558-4717 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 251B00000X Case Management | |
| 251T00000X Program of All-Inclusive Care for the Elderly (PACE) Provider Organization | |
| 261QM1000X Clinic/Center Migrant Health | |
| 261QP2300X Clinic/Center Primary Care | |
| 261QR1300X Clinic/Center Rural Health | |
| 302R00000X Health Maintenance Organization | |
| 305S00000X Point of Service | |
| Enumeration Date | 2020-07-28 |
| Last Update Date | 2023-03-28 |