Provider Demographics
NPI:1467005538
Name:SOCIAL WELLNESS ADVOCACY GROUP, LLC
Entity Type:Organization
Organization Name:SOCIAL WELLNESS ADVOCACY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TEKISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DURAND
Authorized Official - Suffix:
Authorized Official - Credentials:RCSWI
Authorized Official - Phone:786-707-5713
Mailing Address - Street 1:890 NW 213TH TER APT 203
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-2181
Mailing Address - Country:US
Mailing Address - Phone:786-707-5713
Mailing Address - Fax:
Practice Address - Street 1:41 NE 95TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2706
Practice Address - Country:US
Practice Address - Phone:786-707-5713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1952785388Medicaid