Healthcare Provider Details

I. General information

NPI: 1265018543
Provider Name (Legal Business Name): ALEGRIA COMMUNITY MENTAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2021
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NW 79TH AVE STE 265
DORAL FL
33122-1088
US

IV. Provider business mailing address

2500 NW 79TH AVE STE 265
DORAL FL
33122-1088
US

V. Phone/Fax

Practice location:
  • Phone: 305-390-4284
  • Fax: 305-390-4318
Mailing address:
  • Phone: 305-390-4284
  • Fax: 305-390-4318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
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: GLENDA BETANCOURT
Title or Position: OWNER
Credential:
Phone: 786-797-3791