Provider Demographics
NPI:1942685144
Name:FLORIDA HOUSE PHYSICIANS GROUP
Entity type:Organization
Organization Name:FLORIDA HOUSE PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:TEJEIRO
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-880-2730
Mailing Address - Street 1:505 S FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-4109
Mailing Address - Country:US
Mailing Address - Phone:954-880-2730
Mailing Address - Fax:
Practice Address - Street 1:505 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-4109
Practice Address - Country:US
Practice Address - Phone:954-880-2730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW9236324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility