Provider Demographics
NPI:1134859325
Name:EMERGENCY SERVICES PROVIDER GROUP, INC
Entity type:Organization
Organization Name:EMERGENCY SERVICES PROVIDER GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MALIK
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-508-8555
Mailing Address - Street 1:PO BOX 2112
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33061-2112
Mailing Address - Country:US
Mailing Address - Phone:405-921-6935
Mailing Address - Fax:888-323-2806
Practice Address - Street 1:1950 NE 6TH ST UNIT 2112
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-6541
Practice Address - Country:US
Practice Address - Phone:561-508-8555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty