Healthcare Provider Details

I. General information

NPI: 1760608723
Provider Name (Legal Business Name): PEDIATRIC ALTERNATIVE TREATMENT CARE HOUSING AND EVALUATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 S KROME AVE SUITE 104-107
FLORIDA CITY FL
33034-4906
US

IV. Provider business mailing address

335 S KROME AVE SUITE 104
FLORIDA CITY FL
33034-4906
US

V. Phone/Fax

Practice location:
  • Phone: 305-242-8122
  • Fax: 305-242-8837
Mailing address:
  • Phone: 305-242-8122
  • Fax: 305-242-8837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. AZONA K SMITH
Title or Position: CEO
Credential:
Phone: 305-242-8122