Provider Demographics
NPI:1104004480
Name:ARCHWAYS
Entity Type:Organization
Organization Name:ARCHWAYS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-763-2030
Mailing Address - Street 1:919 NE 13TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-2009
Mailing Address - Country:US
Mailing Address - Phone:954-763-2030
Mailing Address - Fax:954-763-9847
Practice Address - Street 1:919 NE 13TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-2009
Practice Address - Country:US
Practice Address - Phone:954-763-2030
Practice Address - Fax:954-763-9847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW6590251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL754932600Medicaid
FL74537YOtherMEDICARE PROVIDER