Basic Information
| Provider Information | |||||||||
| NPI: | 1952440208 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHILDRENS COMPREHENSIVE CARE 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: | 200 SE 19TH AVENUE | ||||||||
| Address2: | |||||||||
| City: | POMPANO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549437336 | ||||||||
| FaxNumber: | 9545459891 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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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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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3140N1450X | FL | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility | Nursing Care, Pediatric |
No ID Information.