Basic Information
| Provider Information | |||||||||
| NPI: | 1033391727 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BROWARD HOUSE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1726 SE 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333162514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545224749 | ||||||||
| FaxNumber: | 9545229357 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 SE 18TH CT | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333162833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545239454 | ||||||||
| FaxNumber: | 9545237622 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2007 | ||||||||
| LastUpdateDate: | 03/03/2016 | ||||||||
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| AuthorizedOfficialLastName: | HYDE | ||||||||
| AuthorizedOfficialFirstName: | STACY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 9545224749 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | FL | Y | Agencies | Community/Behavioral Health |
No ID Information.