MEDICARE: HIALEAH COMMUNITY MENTAL HEALTH CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1770591836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIALEAH COMMUNITY MENTAL HEALTH CENTER INC

Provider Business Mailing Address
First Line	:	755 E 8TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-4613
Country	:	US
Telephone Number	:	305-888-5730
Fax Number	:	305-888-5732

Provider Business Practice Location Address
First Line	:	755 E 8TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-4613
Country	:	US
Telephone Number	:	305-888-5730
Fax Number	:	305-888-5732

Authorized Official
Title or Position	:	OWNER
Name	:	MAGALY D GOMEZ
Credential	:
Telephone Number	:	305-888-5730

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	06/10/2009

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