Healthcare Provider Details

I. General information

NPI: 1780290627
Provider Name (Legal Business Name): SOCIAL INTEGRITY MENTAL HEALTH CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 10/20/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13012 SW 85TH AVENUE RD
MIAMI FL
33156-6502
US

IV. Provider business mailing address

15780 SW 148TH TER
MIAMI FL
33196-5704
US

V. Phone/Fax

Practice location:
  • Phone: 305-762-0840
  • Fax:
Mailing address:
  • Phone: 305-762-0840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AIXA PEREZ ALBA
Title or Position: MANAGER
Credential:
Phone: 305-762-0840