| Crockett Foundation Inc | |
|
401 Sw 1st Ave Ste 102 Fort Lauderdale FL 33301-2853 | |
| (754) 666-3928 | |
| Not Available |
| Full Name | Crockett Foundation Inc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 401 Sw 1st Ave Ste 102, Fort Lauderdale, Florida |
| Authorized Official Name and Position | Regine Kanzki (VICE PRESIDENT OF OPERATIONS) |
| Authorized Official Contact | 9548229370 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Crockett Foundation Inc 401 Sw 1st Ave Ste 102 Fort Lauderdale FL 33301-2853 Ph: (754) 666-3928 | Crockett Foundation Inc 401 Sw 1st Ave Ste 102 Fort Lauderdale FL 33301-2853 Ph: (754) 666-3928 |
| NPI Number | 1184295123 |
|---|---|
| Provider Enumeration Date | 07/09/2021 |
| Last Update Date | 07/09/2021 |
| Certification Date | 07/09/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184295123 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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