Provider Demographics
NPI:1679818090
Name:MIZELL PALLIATIVE CARE CENTER
Entity Type:Organization
Organization Name:MIZELL PALLIATIVE CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:C
Authorized Official - Last Name:JEANTY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:954-895-1960
Mailing Address - Street 1:4801 S UNIVERSITY DR
Mailing Address - Street 2:#249
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3839
Mailing Address - Country:US
Mailing Address - Phone:954-680-4352
Mailing Address - Fax:954-642-9438
Practice Address - Street 1:4801 S UNIVERSITY DR
Practice Address - Street 2:#249
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-3839
Practice Address - Country:US
Practice Address - Phone:954-680-4352
Practice Address - Fax:954-642-9438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage