MEDICARE: HEALING BRIDGE COMMUNITY CENTER CORP

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	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891387072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING BRIDGE COMMUNITY CENTER CORP

Provider Business Mailing Address
First Line	:	261 WESTWARD DR STE 202
Second Line	:
City	:	MIAMI SPRINGS
State	:	FL
Zip	:	33166-5208
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	261 WESTWARD DR STE 202
Second Line	:
City	:	MIAMI SPRINGS
State	:	FL
Zip	:	33166-5208
Country	:	US
Telephone Number	:	786-616-2026
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT AND EXECUTIVE DIRECTOR
Name	:	ENEIDIS ALDAZ FERNANDEZ
Credential	:
Telephone Number	:	786-616-2026

Provider Enumeration Date	:	02/09/2021
Last Update Date	:	02/09/2021

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Directions to “HEALING BRIDGE COMMUNITY CENTER CORP ” Practice Location

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