Healthcare Provider Details

I. General information

NPI: 1346293511
Provider Name (Legal Business Name): INSTITUTE FOR CHILD AND FAMILY HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15490 NW 7TH AVE STE 201
MIAMI FL
33169-6250
US

IV. Provider business mailing address

15490 NW 7TH AVE STE 201
MIAMI DADE FL
33169-6250
US

V. Phone/Fax

Practice location:
  • Phone: 305-685-8245
  • Fax: 305-681-4355
Mailing address:
  • Phone: 305-685-8245
  • Fax: 305-681-4355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number060286803
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number060286801
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number060286800
License Number StateFL

VIII. Authorized Official

Name: MRS. IRENE M PHILLIPS
Title or Position: CHIEF OPERATING OFFICER CFO
Credential:
Phone: 305-722-5320