Provider Demographics
NPI:1972850626
Name:SPAULDING,S INTAKE AND REFERRAL AGENCY INC.
Entity Type:Organization
Organization Name:SPAULDING,S INTAKE AND REFERRAL AGENCY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:VENETA
Authorized Official - Middle Name:ANGELA
Authorized Official - Last Name:BURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:954-965-8292
Mailing Address - Street 1:6151 MIRAMAR PKWY (SUITE 116)
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025
Mailing Address - Country:US
Mailing Address - Phone:954-965-8292
Mailing Address - Fax:954-965-8292
Practice Address - Street 1:6151 MIRAMAR PKWY STE 116
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-3987
Practice Address - Country:US
Practice Address - Phone:954-965-8292
Practice Address - Fax:954-965-8292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1706AD895301251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health