Healthcare Provider Details

I. General information

NPI: 1336152347
Provider Name (Legal Business Name): COMMUNITY HEALTH OF SOUTH FLORIDA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 SW 216TH ST
MIAMI FL
33190-1003
US

IV. Provider business mailing address

10300 SW 216TH STREET
MIAMI FL
33190-1003
US

V. Phone/Fax

Practice location:
  • Phone: 305-253-5100
  • Fax: 305-252-5881
Mailing address:
  • Phone: 305-253-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number3928521
License Number StateFL

VIII. Authorized Official

Name: BRODES H. HARTLEY JR.
Title or Position: CEO
Credential:
Phone: 305-253-5100