Provider Demographics
NPI:1770029183
Name:CORAHEALINGHANDS PSYCHIATRIC SERVICES INC
Entity type:Organization
Organization Name:CORAHEALINGHANDS PSYCHIATRIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLEY
Authorized Official - Middle Name:F
Authorized Official - Last Name:POWELL-MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:954-851-9690
Mailing Address - Street 1:14201 W SUNRISE BLVD
Mailing Address - Street 2:208
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-3207
Mailing Address - Country:US
Mailing Address - Phone:954-851-9690
Mailing Address - Fax:
Practice Address - Street 1:14421 WEST SUNRISE BOULEVARD SUITE
Practice Address - Street 2:208
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323
Practice Address - Country:US
Practice Address - Phone:954-851-9690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9209943363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty