Healthcare Provider Details

I. General information

NPI: 1053902767
Provider Name (Legal Business Name): ALL WELLNESS COMMUNITY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10671 N KENDALL DR STE 5D
MIAMI FL
33176-1510
US

IV. Provider business mailing address

1150 NW 72ND AVE STE 100
MIAMI FL
33126-1920
US

V. Phone/Fax

Practice location:
  • Phone: 786-416-0811
  • Fax:
Mailing address:
  • Phone: 786-416-0811
  • Fax: 786-558-5483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. VANIA MERCEDES SIMON
Title or Position: PRESIDENT
Credential: LMHC
Phone: 786-416-0811