Provider Demographics
NPI:1568854180
Name:CENTRA HEALTHCARE
Entity Type:Organization
Organization Name:CENTRA HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR SEARCH CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:KYLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-636-2525
Mailing Address - Street 1:1000 CORPORATE DR
Mailing Address - Street 2:SUITE 280
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33334-3634
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 CORPORATE DR
Practice Address - Street 2:SUITE 280
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334-3634
Practice Address - Country:US
Practice Address - Phone:954-594-4267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 29236261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center