Provider Demographics
NPI:1730285883
Name:MEDIVAN HEALTH AND COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:MEDIVAN HEALTH AND COMMUNITY SERVICES, INC.
Other - Org Name:MEDIVAN PROJECT
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, DPA
Authorized Official - Phone:954-735-9019
Mailing Address - Street 1:5101 NW 21ST AVE
Mailing Address - Street 2:SUITE 510
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-2792
Mailing Address - Country:US
Mailing Address - Phone:954-735-9019
Mailing Address - Fax:954-733-9315
Practice Address - Street 1:5101 NW 21ST AVE
Practice Address - Street 2:SUITE 510
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-2792
Practice Address - Country:US
Practice Address - Phone:954-735-9019
Practice Address - Fax:954-733-9315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable