Provider Demographics
NPI:1588448625
Name:ANGEL CLINICAL THERAPY OF BROWARD LLC
Entity type:Organization
Organization Name:ANGEL CLINICAL THERAPY OF BROWARD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CODECIDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-663-2822
Mailing Address - Street 1:4961 SW 148TH AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-2419
Mailing Address - Country:US
Mailing Address - Phone:786-663-2822
Mailing Address - Fax:
Practice Address - Street 1:4961 SW 148TH AVE
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-2419
Practice Address - Country:US
Practice Address - Phone:786-663-2822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)