Healthcare Provider Details

I. General information

NPI: 1821351685
Provider Name (Legal Business Name): GARDEN GENERAL SERVICE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10021 SW 40TH ST
MIAMI FL
33165-3945
US

IV. Provider business mailing address

10021 SW 40TH ST
MIAMI FL
33165-3945
US

V. Phone/Fax

Practice location:
  • Phone: 305-614-1172
  • Fax: 305-640-5705
Mailing address:
  • Phone: 305-614-1172
  • Fax: 305-640-5705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberMA67461
License Number StateFL

VIII. Authorized Official

Name: MISS BARBARA GONZALEZ
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 305-614-1172