Provider Demographics
NPI:1700385093
Name:SOUTH FLORIDA CARE CENTER, INC.
Entity Type:Organization
Organization Name:SOUTH FLORIDA CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER ENROLLMENT ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:MARDOCHEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONESTIME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-328-4352
Mailing Address - Street 1:7435 AVENIDA DEL MAR APT 2806
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-4879
Mailing Address - Country:US
Mailing Address - Phone:561-929-4808
Mailing Address - Fax:
Practice Address - Street 1:2025A N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-4968
Practice Address - Country:US
Practice Address - Phone:561-929-4808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-01
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty