Provider Demographics
NPI:1871843045
Name:FAMILY RESOURCE CENTER OF SOUTH FLORIDA
Entity type:Organization
Organization Name:FAMILY RESOURCE CENTER OF SOUTH FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WUNDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:305-960-5521
Mailing Address - Street 1:155 S MIAMI AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-1617
Mailing Address - Country:US
Mailing Address - Phone:305-812-2902
Mailing Address - Fax:
Practice Address - Street 1:155 SOUTH MIAMI AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137
Practice Address - Country:US
Practice Address - Phone:305-812-2902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
FLNONE251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100022541OtherCHILD PLACEMENT AGENCY PROVIDER NUMBER
FL070390700Medicaid