Provider Demographics
NPI:1164448197
Name:FLORIDA COMPLETE WELLNESS, INC.
Entity Type:Organization
Organization Name:FLORIDA COMPLETE WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FARRAR
Authorized Official - Middle Name:VALINE
Authorized Official - Last Name:DURO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-765-6505
Mailing Address - Street 1:3408 W 84TH ST STE 309
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4944
Mailing Address - Country:US
Mailing Address - Phone:954-765-6505
Mailing Address - Fax:
Practice Address - Street 1:3408 W 84TH ST STE 309
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-4944
Practice Address - Country:US
Practice Address - Phone:954-765-6505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108300200Medicaid