Provider Demographics
NPI:1578013686
Name:SOUTH FLORIDA WELLNESS CENTER INC
Entity Type:Organization
Organization Name:SOUTH FLORIDA WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTOINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-300-6045
Mailing Address - Street 1:4100 S HOSPITAL DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2813
Mailing Address - Country:US
Mailing Address - Phone:954-990-5922
Mailing Address - Fax:954-357-3624
Practice Address - Street 1:4100 S HOSPITAL DR
Practice Address - Street 2:SUITE 102
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2813
Practice Address - Country:US
Practice Address - Phone:954-990-5922
Practice Address - Fax:954-357-3624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Single Specialty