Provider Demographics
NPI:1811105224
Name:NATC FT LAUDERDALE
Entity type:Organization
Organization Name:NATC FT LAUDERDALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-545-7564
Mailing Address - Street 1:2901 W OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE A4-5
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1243
Mailing Address - Country:US
Mailing Address - Phone:954-677-5800
Mailing Address - Fax:954-677-5805
Practice Address - Street 1:2901 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE A4-5
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33311-1243
Practice Address - Country:US
Practice Address - Phone:954-677-5800
Practice Address - Fax:954-677-5805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health