Provider Demographics
NPI:1194348052
Name:OPEN FOOD INC
Entity type:Organization
Organization Name:OPEN FOOD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:954-289-2811
Mailing Address - Street 1:476 SE 14TH ST
Mailing Address - Street 2:
Mailing Address - City:DANIA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33004-5335
Mailing Address - Country:US
Mailing Address - Phone:954-289-2811
Mailing Address - Fax:
Practice Address - Street 1:476 SE 14TH ST
Practice Address - Street 2:
Practice Address - City:DANIA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33004-5335
Practice Address - Country:US
Practice Address - Phone:954-289-2811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health