Healthcare Provider Details

I. General information

NPI: 1114991544
Provider Name (Legal Business Name): DOUGLAS GARDENS COMMUNITY MENTAL HEALTH CENTER OF MIAMI BEACH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 MERIDIAN AVE SUITE 501
MIAMI BEACH FL
33139
US

IV. Provider business mailing address

1680 MERIDIAN AVE STE 501
MIAMI BEACH FL
33139-2719
US

V. Phone/Fax

Practice location:
  • Phone: 305-531-5341
  • Fax: 305-532-5322
Mailing address:
  • Phone: 305-531-5341
  • Fax: 305-532-5322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberKH909
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberKH909
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License NumberKH909
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberKH909
License Number StateFL

VIII. Authorized Official

Name: LARRY J LONG
Title or Position: CFO
Credential: MACC
Phone: 305-531-5341