Provider Demographics
NPI:1760375984
Name:FOUR WALLS STUDIO LLC
Entity type:Organization
Organization Name:FOUR WALLS STUDIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:ROUDELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CELESTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-934-3497
Mailing Address - Street 1:6941 SW 196TH AVE UNIT 21-2
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33332
Mailing Address - Country:US
Mailing Address - Phone:305-924-3497
Mailing Address - Fax:
Practice Address - Street 1:6941 SW 196TH AVE UNIT 21-2
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33332
Practice Address - Country:US
Practice Address - Phone:305-924-3497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care