Healthcare Provider Details

I. General information

NPI: 1740540608
Provider Name (Legal Business Name): MIAMI DADE COMMUNITY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 SW 1ST ST
MIAMI FL
33135-1601
US

IV. Provider business mailing address

1901 SW 1ST ST FL 2
MIAMI FL
33135-1601
US

V. Phone/Fax

Practice location:
  • Phone: 305-631-8931
  • Fax: 305-631-0546
Mailing address:
  • Phone: 305-631-8931
  • Fax: 305-631-0546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW1612
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number1113AD310901
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1113AD310901
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number1113AD310901
License Number StateFL

VIII. Authorized Official

Name: JOSE M ROIG
Title or Position: PRESIDENT
Credential: HEALTHCARE MANGMNT
Phone: 305-631-8931