Provider Demographics
NPI:1194963744
Name:BRCH WOMEN'S INSTITUTE FOR HEALTH AND WELLNESS, INC.
Entity type:Organization
Organization Name:BRCH WOMEN'S INSTITUTE FOR HEALTH AND WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:MORELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-955-2141
Mailing Address - Street 1:690 MEADOWS ROAD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486
Mailing Address - Country:US
Mailing Address - Phone:561-955-2141
Mailing Address - Fax:561-955-2132
Practice Address - Street 1:690 MEADOWS RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2344
Practice Address - Country:US
Practice Address - Phone:561-955-2141
Practice Address - Fax:561-955-2132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0054973174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1558582213OtherUPIN F13025