Provider Demographics
NPI:1821021361
Name:THE POVERELLO CENTER INC
Entity Type:Organization
Organization Name:THE POVERELLO CENTER INC
Other - Org Name:POVERELLO FOOD AND NUTRITION CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-213-6597
Mailing Address - Street 1:2056 N DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-2270
Mailing Address - Country:US
Mailing Address - Phone:954-561-3663
Mailing Address - Fax:954-213-6597
Practice Address - Street 1:2056 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-2270
Practice Address - Country:US
Practice Address - Phone:954-561-3663
Practice Address - Fax:954-213-6597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2005-06251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable