1043586316 NPI number — FLORIDA HOPE HEALTHCARE SERVICES INC

Table of content: GAYLA A. JONES LCMHC (NPI 1043513328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043586316 NPI number — FLORIDA HOPE HEALTHCARE SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA HOPE HEALTHCARE SERVICES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043586316
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 SW 3RD ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
POMPANO BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33069-3240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-788-7555
Provider Business Mailing Address Fax Number:
954-317-5626

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 SW 3RD ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
POMPANO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33069-3240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-788-7555
Provider Business Practice Location Address Fax Number:
954-317-5626
Provider Enumeration Date:
03/30/2012

Additional Information

Authorized Official

Authorized Official Last Name:
DESIR
Authorized Official First Name:
CHANTAL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
954-788-7555

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  299994052 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 009641400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com