FIFTH STREET COUNSELING CENTER IV
Ambulatory Health at 5 St, Fort Lauderdale, FL

License number
Florida 1706AD527901
Category
Ambulatory Health
Type
Rehabilitation, Substance Use Disorder
Owner
Name: JOSE FLORES
Title: BILLING COORDINATOR
Phone: (754) 201-2265
Address
Address
4121 NW 5Th St STE 206, Fort Lauderdale, FL 33317
National Provider ID: 1619224102
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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FIFTH STREET COUNSELING CENTER IV, INC

4121 NW 5 St SUITE 206, Fort Lauderdale, FL 33317

Industry:
Specialty Outpatient Clinic
Registration:
Aug 14, 1997
State ID:
P97000070696
Business type:
Florida Profit Corporation
President, Secretarys:
Garry Smyth (Vice President), 4121 NW 5 St, Fort Lauderdale, FL 33317 (Physical),Kathleen M. Rhodes (President, Secretary, Treasurer), 4121 NW 5 St, Fort Lauderdale, FL 33317 (Physical),Rhodes Kathleen M President, Secretary, inactive, 4121 NW 5 St STE 206, Fort Lauderdale, FL 33317 (Physical)
Agent:
Kathleen Rhodes,4121 NW 5 St SUITE 206, Fort Lauderdale, FL 33317 (Physical)
EIN:
65-0755279

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