Provider Demographics
NPI:1235864372
Name:SOUTH FLORIDA WELLNESS SERVICES, INC
Entity Type:Organization
Organization Name:SOUTH FLORIDA WELLNESS SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KEISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEARD
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:754-202-6889
Mailing Address - Street 1:6151 MIRAMAR PKWY STE 308
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-3985
Mailing Address - Country:US
Mailing Address - Phone:833-732-7462
Mailing Address - Fax:833-732-7462
Practice Address - Street 1:6151 MIRAMAR PKWY STE 308
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-3985
Practice Address - Country:US
Practice Address - Phone:833-732-7462
Practice Address - Fax:833-732-7462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-21
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility