Healthcare Provider Details

I. General information

NPI: 1114805165
Provider Name (Legal Business Name): BENJAMIN COMMUNITY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 HOLLYWOOD BLVD STE 1B
HOLLYWOOD FL
33021-6749
US

IV. Provider business mailing address

3939 HOLLYWOOD BLVD STE 1B
HOLLYWOOD FL
33021-6749
US

V. Phone/Fax

Practice location:
  • Phone: 954-251-0267
  • Fax: 954-239-7987
Mailing address:
  • Phone: 954-251-0267
  • Fax: 954-239-7987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ILNISE MATHIEU
Title or Position: OFFICE MANAGER
Credential:
Phone: 954-251-0267