Provider Demographics
NPI:1073679056
Name:SERVICE HEALING CLINIC INC.
Entity Type:Organization
Organization Name:SERVICE HEALING CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HUMBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-584-0315
Mailing Address - Street 1:4300 10TH AVE N
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-2322
Mailing Address - Country:US
Mailing Address - Phone:561-584-0315
Mailing Address - Fax:305-675-2668
Practice Address - Street 1:4300 10TH AVE N
Practice Address - Street 2:SUITE 3
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-2322
Practice Address - Country:US
Practice Address - Phone:561-584-0315
Practice Address - Fax:305-675-2668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7438261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC7438OtherAHCA LICENSE