Provider Demographics
NPI:1861016115
Name:CENTERS FOR HEALTH PROMOTION, LLC
Entity Type:Organization
Organization Name:CENTERS FOR HEALTH PROMOTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:C
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-368-8784
Mailing Address - Street 1:1890 N UNIVERSITY DR STE 306
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-8963
Mailing Address - Country:US
Mailing Address - Phone:954-368-8784
Mailing Address - Fax:
Practice Address - Street 1:1890 N UNIVERSITY DR STE 306
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-8963
Practice Address - Country:US
Practice Address - Phone:954-368-8784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-02
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care