Provider Demographics
NPI:1437585866
Name:THE WONDER SPROUT INC
Entity Type:Organization
Organization Name:THE WONDER SPROUT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-444-6003
Mailing Address - Street 1:29629 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-3320
Mailing Address - Country:US
Mailing Address - Phone:786-444-6003
Mailing Address - Fax:
Practice Address - Street 1:29629 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-3320
Practice Address - Country:US
Practice Address - Phone:786-444-6003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes102X00000XBehavioral Health & Social Service ProvidersPoetry TherapistGroup - Single Specialty