Healthcare Provider Details

I. General information

NPI: 1023606563
Provider Name (Legal Business Name): THE VILLAGE SOUTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 BLUE LAGOON DR STE 445
MIAMI FL
33126-7006
US

IV. Provider business mailing address

PO BOX 94738
LAS VEGAS NV
89193-4738
US

V. Phone/Fax

Practice location:
  • Phone: 305-696-0738
  • Fax:
Mailing address:
  • Phone: 702-385-2090
  • Fax: 702-924-2575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DANNY BLANCO
Title or Position: DIRECTOR
Credential:
Phone: 305-696-0738