Healthcare Provider Details

I. General information

NPI: 1639743602
Provider Name (Legal Business Name): SHALENA COMMUNITY CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2021
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3817 W FLAGLER ST
CORAL GABLES FL
33134-1603
US

IV. Provider business mailing address

3817 W FLAGLER ST
CORAL GABLES FL
33134-1603
US

V. Phone/Fax

Practice location:
  • Phone: 305-456-2776
  • Fax: 305-456-2515
Mailing address:
  • Phone: 305-456-2776
  • Fax: 305-456-2515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: YAIMA SANCHEZ VEGA
Title or Position: PRESIDENT
Credential:
Phone: 305-456-2776