Provider Demographics
NPI:1568674356
Name:BROWARD COMMUNITY CENTER INC
Entity Type:Organization
Organization Name:BROWARD COMMUNITY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSY
Authorized Official - Middle Name:
Authorized Official - Last Name:SADOVNIK
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, PSYD
Authorized Official - Phone:954-907-2092
Mailing Address - Street 1:516 NE 13TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-1140
Mailing Address - Country:US
Mailing Address - Phone:954-907-2092
Mailing Address - Fax:954-462-0370
Practice Address - Street 1:516 NE 13TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-1140
Practice Address - Country:US
Practice Address - Phone:954-907-2092
Practice Address - Fax:954-462-0370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1114026903Medicare ID - Type UnspecifiedPSYCHOLOGIST
FL1346223658Medicare ID - Type UnspecifiedPSYCHIATRIST