Healthcare Provider Details

I. General information

NPI: 1285178178
Provider Name (Legal Business Name): GREEN CROSS CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2016
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 SE 8TH ST STE 104
HIALEAH FL
33010-5646
US

IV. Provider business mailing address

730 SE 8TH ST STE 104
HIALEAH FL
33010-5646
US

V. Phone/Fax

Practice location:
  • Phone: 305-557-3444
  • Fax: 305-557-3445
Mailing address:
  • Phone: 305-557-3444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ALESSANDRO MORIYON
Title or Position: DIRECTOR
Credential:
Phone: 786-239-2051