Provider Demographics
NPI:1891175683
Name:SUSAN B. ANTHONY CENTER, INC.
Entity Type:Organization
Organization Name:SUSAN B. ANTHONY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DALBERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-733-6068
Mailing Address - Street 1:1633 POINCIANA DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-4587
Mailing Address - Country:US
Mailing Address - Phone:954-733-6068
Mailing Address - Fax:954-733-0766
Practice Address - Street 1:8910 MIRAMAR PKWY
Practice Address - Street 2:SUITE #312
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-4100
Practice Address - Country:US
Practice Address - Phone:954-733-6068
Practice Address - Fax:954-733-0766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-05
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1706AD308902251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070669802Medicaid