Provider Demographics
NPI:1932542784
Name:POMPANO BEACH HEALING CENTER, INC
Entity Type:Organization
Organization Name:POMPANO BEACH HEALING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MANOUCHKA
Authorized Official - Middle Name:
Authorized Official - Last Name:PROCHETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-876-0595
Mailing Address - Street 1:901 E SAMPLE RD
Mailing Address - Street 2:#I
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-5160
Mailing Address - Country:US
Mailing Address - Phone:954-876-0595
Mailing Address - Fax:954-876-0597
Practice Address - Street 1:901 EAST SAMPLE ROAD
Practice Address - Street 2:#I
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064
Practice Address - Country:US
Practice Address - Phone:954-876-0595
Practice Address - Fax:954-876-0597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5020261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service