Healthcare Provider Details

I. General information

NPI: 1821876343
Provider Name (Legal Business Name): PHP MENTAL HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 09/18/2023
Certification Date: 09/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10665 SW 190TH ST STE 3213
CUTLER BAY FL
33157-7706
US

IV. Provider business mailing address

10665 SW 190TH ST STE 3213
CUTLER BAY FL
33157-7706
US

V. Phone/Fax

Practice location:
  • Phone: 786-380-2077
  • Fax:
Mailing address:
  • Phone: 786-380-2077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANACECILIA CASANOVA
Title or Position: PRESIDENT
Credential:
Phone: 786-380-2077