Healthcare Provider Details

I. General information

NPI: 1962016048
Provider Name (Legal Business Name): PRO COMMUNITY SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2020
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 W 16TH AVE STE 138U
HIALEAH FL
33012-4661
US

IV. Provider business mailing address

3750 W 16TH AVE STE 138U
HIALEAH FL
33012-4661
US

V. Phone/Fax

Practice location:
  • Phone: 786-881-0010
  • Fax: 305-200-5631
Mailing address:
  • Phone: 786-881-0010
  • Fax: 305-200-5631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: IDIANA HERNANDEZ
Title or Position: PRESIDENT
Credential:
Phone: 786-370-1904