Provider Demographics
NPI:1326774308
Name:PEMBROKE PINES COMMUNITY HEALTH CENTER INC
Entity Type:Organization
Organization Name:PEMBROKE PINES COMMUNITY HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLEOPATRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON-PUSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-442-0029
Mailing Address - Street 1:222 S FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1721
Mailing Address - Country:US
Mailing Address - Phone:954-442-0029
Mailing Address - Fax:954-357-2353
Practice Address - Street 1:222 S FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1721
Practice Address - Country:US
Practice Address - Phone:954-442-0029
Practice Address - Fax:954-357-2353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty