Healthcare Provider Details

I. General information

NPI: 1144975418
Provider Name (Legal Business Name): ALINA HEALTH MEDICAL CENTER CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 N STATE ROAD 7 STE C
LAUDERDALE LAKES FL
33319-5811
US

IV. Provider business mailing address

4800 N STATE ROAD 7 STE ABANDC
LAUDERDALE LAKES FL
33319-5811
US

V. Phone/Fax

Practice location:
  • Phone: 305-767-0887
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: GRAVIL JOSEPH
Title or Position: OWNER
Credential: MD
Phone: 305-767-0887