Healthcare Provider Details

I. General information

NPI: 1568846756
Provider Name (Legal Business Name): HIS HOUSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20000 NW 47TH AVE HECTOR BUILDING NO. 2
MIAMI GARDENS FL
33055-1543
US

IV. Provider business mailing address

20000 NW 47TH AVE HECTOR BUILDING NO. 2
MIAMI GARDENS FL
33055-1543
US

V. Phone/Fax

Practice location:
  • Phone: 305-430-0085
  • Fax: 305-474-8533
Mailing address:
  • Phone: 305-430-0085
  • Fax: 305-474-8533

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 Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number StateFL

VIII. Authorized Official

Name: MRS. SILVIA SMITH-TORRES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 305-430-0085