Provider Demographics
NPI:1245595024
Name:AMI KIDS GREATER FORT LAUDERDALE
Entity Type:Organization
Organization Name:AMI KIDS GREATER FORT LAUDERDALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CERUTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-764-2733
Mailing Address - Street 1:3220 SW 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33315-3019
Mailing Address - Country:US
Mailing Address - Phone:954-764-2733
Mailing Address - Fax:954-764-3128
Practice Address - Street 1:3220 SW 4TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33315-3019
Practice Address - Country:US
Practice Address - Phone:954-764-2733
Practice Address - Fax:954-764-3128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL338756251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health