| Sunnyside Love Extravagant Group Llc | |
|
3600 S State Road 7 Ste 344 Miramar FL 33023-7203 | |
| (786) 575-3801 | |
| (877) 384-2630 |
| Full Name | Sunnyside Love Extravagant Group Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 3600 S State Road 7 Ste 344, Miramar, Florida |
| Authorized Official Name and Position | Tabitha S Taylor-boone (OWNER) |
| Authorized Official Contact | 7865753801 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sunnyside Love Extravagant Group Llc 3600 S State Road 7 Ste 344 Miramar FL 33023-7203 Ph: (786) 575-3801 | Sunnyside Love Extravagant Group Llc 3600 S State Road 7 Ste 344 Miramar FL 33023-7203 Ph: (786) 575-3801 |
| NPI Number | 1629603154 |
|---|---|
| Provider Enumeration Date | 03/04/2020 |
| Last Update Date | 08/08/2021 |
| Certification Date | 08/08/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629603154 | NPI | - | NPPES |
| 1750945689 | Other | FL | NPI |
| 022925900 | Medicaid | FL |
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