Provider Demographics
NPI:1063653079
Name:COMPREHENSIVE CARE OF BROWARD, INC.
Entity Type:Organization
Organization Name:COMPREHENSIVE CARE OF BROWARD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LYUBOV
Authorized Official - Middle Name:
Authorized Official - Last Name:PAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-454-8880
Mailing Address - Street 1:212 NE 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4230
Mailing Address - Country:US
Mailing Address - Phone:954-454-8880
Mailing Address - Fax:954-454-1594
Practice Address - Street 1:212 NE 1ST AVE
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4230
Practice Address - Country:US
Practice Address - Phone:954-454-8880
Practice Address - Fax:954-454-1594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 8239261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)