Provider Demographics
NPI:1891509790
Name:SOUTHWELL HEALTHCARE INC
Entity type:Organization
Organization Name:SOUTHWELL HEALTHCARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIRAHAYDEE
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA-ALCANTARA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:717-916-8077
Mailing Address - Street 1:1806 N FLAMINGO RD STE 347
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1040
Mailing Address - Country:US
Mailing Address - Phone:877-354-5338
Mailing Address - Fax:800-500-1921
Practice Address - Street 1:1806 N FLAMINGO RD STE 347
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1040
Practice Address - Country:US
Practice Address - Phone:954-638-9197
Practice Address - Fax:800-500-1921
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWELL HEALTHCARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-03
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty