Provider Demographics
NPI:1710574108
Name:MEMORIAL HEALTHCARE SYSTEM
Entity Type:Organization
Organization Name:MEMORIAL HEALTHCARE SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PEER SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDAISE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOZELL-HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:CRPS
Authorized Official - Phone:954-662-6107
Mailing Address - Street 1:7031 TAFT ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3864
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7031 TAFT ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-3864
Practice Address - Country:US
Practice Address - Phone:954-662-6107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty