Basic Information
| Provider Information | |||||||||
| NPI: | 1831224609 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BROWARD CHILDRENS CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 SE 19TH AVENUE | ||||||||
| Address2: | |||||||||
| City: | POMPANO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549437336 | ||||||||
| FaxNumber: | 9545459891 | ||||||||
| Practice Location | |||||||||
| Address1: | 104 SE 20TH AVENUE | ||||||||
| Address2: | |||||||||
| City: | POMPANO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549439589 | ||||||||
| FaxNumber: | 9549434115 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2007 | ||||||||
| LastUpdateDate: | 10/18/2022 | ||||||||
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| AuthorizedOfficialLastName: | EVANS | ||||||||
| AuthorizedOfficialFirstName: | MARJORIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9549437336 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 10/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | 880197500 | 05 | FL | MEDICAID |