Provider Demographics
NPI:1144649161
Name:PASSAGE HEALTH INTERNATIONAL
Entity type:Organization
Organization Name:PASSAGE HEALTH INTERNATIONAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DIXAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-526-9751
Mailing Address - Street 1:701 E COMMERCIAL BLVD FL 4
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-3392
Mailing Address - Country:US
Mailing Address - Phone:954-903-7445
Mailing Address - Fax:954-376-6163
Practice Address - Street 1:5900 N ANDREWS AVE STE 802
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-2371
Practice Address - Country:US
Practice Address - Phone:954-526-9751
Practice Address - Fax:954-376-6163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-08
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1104238252OtherNPI
FL1104238252OtherNPI