Healthcare Provider Details

I. General information

NPI: 1639230469
Provider Name (Legal Business Name): HEALTHY CONNECTION CMHC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 05/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 SW 37TH AVE SUITE 206
MIAMI FL
33133-2740
US

IV. Provider business mailing address

2780 SW 37TH AVE SUITE 206
MIAMI FL
33133-2740
US

V. Phone/Fax

Practice location:
  • Phone: 305-646-0112
  • Fax:
Mailing address:
  • Phone: 305-646-0112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number002349500
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number076321700
License Number StateFL

VIII. Authorized Official

Name: BEATRIZ MARTINEZ
Title or Position: PRESIDENT
Credential:
Phone: 305-646-0112