Healthcare Provider Details

I. General information

NPI: 1851861934
Provider Name (Legal Business Name): ETERNITY COMMUNITY MENTAL HEALTH CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7570 NW 14TH ST STE 101
MIAMI FL
33126-1701
US

IV. Provider business mailing address

7570 NW 14TH ST STE 101
MIAMI FL
33126-1701
US

V. Phone/Fax

Practice location:
  • Phone: 305-477-6750
  • Fax:
Mailing address:
  • Phone: 305-477-6750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
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 Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. RIGOBERTO CORDERO
Title or Position: OWNER
Credential:
Phone: 786-970-9843